Diagnostic Accuracy of High-Resolution Black-Blood MRI in the Evaluation of Intracranial Large-Vessel Arterial Occlusions

Al-Smadi, Anas S.; Abdalla, R; Elmokadem, Ali H.; Shaibani, Ali; Hurley, Michael C.; Potts, Matthew B.; Jahromi, Babak S.; Carroll, Timothy J.; Ansari, Sameer A.

doi:10.3174/ajnr.a6065

Cited by 33 publications

(27 citation statements)

References 18 publications

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“…The clots breaking up and embolizing the distal segment of BA can cause life threatening complications. HRMRI is helpful in the diagnosis of ICVA occlusion and luminal thrombosis ( 20 ) and can help us to identify the subset of patients with high embolism risk before the procedure. At present, there is no embolic protection device to reduce embolization complications.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Atherosclerotic Non-acute Intracranial Vertebral Artery Total Occlusion: Clinical Features, Imaging Characteristics, Endovascular Recanalization, and Follow-up Outcomes

et al. 2020

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Background and Objectives: Previous studies on symptomatic atherosclerotic non-acute intracranial vertebral artery total occlusion that was refractory to medical therapy are rare. We aimed to assess the clinical features, imaging characteristics, endovascular treatment feasibility and follow-up outcomes of patients with this condition. Methods: Data from consecutive patients who had symptomatic atherosclerotic non-acute intracranial vertebral artery total occlusion and underwent endovascular recanalization from February 2016 to April 2020 were retrospectively collected in our prospective database. Clinical, imaging, procedural, and follow-up data were collected and analyzed. Results: Thirty-one patients, predominantly males, were enrolled in this study. These patients presented with recurrent/progressive stroke in the posterior circulation despite aggressive medical therapy. Angiographic analysis revealed asymmetric vertebral arteries due to unilateral hypoplasia and intracranial vertebral artery total occlusions in the dominant vertebral arteries, which were characterized by long lesion length and high clot burden. Multiple infarctions and perfusion defects in the posterior circulation were demonstrated by diffusion-weighted imaging and arterial spin labeling, respectively. Successful endovascular recanalization was achieved in 87.1% of the patients. Over a median clinical follow-up duration of 11.0 months, 74.1% of patients with successful recanalization achieved favorable clinical outcomes (mRS score ≤2). Conclusion: Symptomatic atherosclerotic non-acute intracranial vertebral artery total occlusion attributable to hypoperfusion is characterized by recurrent/progressive ischemic events, dominant intracranial vertebral artery total occlusion, long lesion length, and high clot burden. Endovascular recanalization of the dominant intracranial vertebral artery occlusion appears to be a feasible treatment for these patients.

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Section: Discussionmentioning

confidence: 99%

Symptomatic Atherosclerotic Non-acute Intracranial Vertebral Artery Total Occlusion: Clinical Features, Imaging Characteristics, Endovascular Recanalization, and Follow-up Outcomes

et al. 2020

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“…Although previous studies have emphasized the diagnostic advantages of 3D IVWI, they focused on the imaging findings of intracranial plaques or the quantification of stenosis in intracranial arteries 14,23–26 . Most of those studies focused on anterior circulation artery territory 4,23,24 …”

Section: Discussionmentioning

confidence: 99%

Assessment of Intracranial Atherosclerotic Plaques Using 3D Black‐Blood MRI: Comparison With 3D Time‐of‐Flight MRA and DSA

Xia

Tian

Shi

et al. 2020

Magnetic Resonance Imaging

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BackgroundNoninvasive assessment of intracranial stenosis is important to manage ischemic stroke patients. However, few previous studies have compared 3D black‐blood MRI with 3D time‐of‐flight (TOF), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA) for intracranial artery plaque assessment.PurposeTo compare 3D black‐blood MRI and 3D TOF‐MRA, using DSA as the reference standard for intracranial stenosis and atherosclerotic plaque assessment in patients with posterior circulation stroke or transient ischemic attacks (TIAs).Study TypeProspective, cohort study.PopulationOne hundred and one patients with posterior circulation stroke and/or TIA (age 63 ± 10 years, 84 male) who underwent DSA and MRI within 4 weeks of each other.Field Strength/Sequence3D fast‐spin‐echo MRI for intracranial vessel wall imaging (IVWI) and 3D TOF at 3T.AssessmentTwo radiologists independently measured the degree of stenosis on 3D IVWI and TOF, using DSA as a reference. Plaque enhancement was recorded when the plaque was stenosis‐free on DSA.Statistical TestsShapiro–Wilk's test, Student's t‐test, Mann–Whitney U‐test, Spearman correlation, Bland–Altman analysis, and interclass correlation coefficient (ICC).ResultsA total of 238 intracranial plaques (203 posterior, 35 anterior) were included. 3D IVWI showed better agreement with DSA in measuring stenosis than TOF (ICC = 0.89 vs. 0.64). 3D IVWI had higher sensitivity and specificity for detecting stenosis >50% and stenosis >75% than TOF, using DSA as the standard. TOF significantly overestimated the degree of stenosis compared to DSA (65 ± 19% vs. 51 ± 15%, P < 0.001). DSA did not observe 62 nonstenotic plaques (26.1%) that were shown only on 3D IVWI, in which 36 plaques (58.1%) showed contrast enhancement. The interreader agreement for measuring stenosis were excellent, with ICCs >0.90 for all three modalities.Data Conclusion3D black‐blood MRI is accurate and reproducible for quantifying intracranial artery stenosis compared with DSA, and performs better than 3D TOF. As compared to DSA, it detects more nonstenotic plaques.Level of Evidence 1Technical Efficacy Stage 2J. MAGN. RESON. IMAGING 2021;53:469–478.

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“…Another potential challenge would be extend the current work for 3D selective excitation, either spatial 3D or 2D and spectral 1D, for high-resolution 3D imaging or spectrally resolved high-resolution 2D imaging. While the benefits of high-resolution 3D imaging have been widely studied for many clinical applications such as vessel wall plaques, ligaments and tumors, [53][54][55] the spatial 2D and spectral 1D excitation pulse would be of particular interest in hyperpolarized small-molecule-metabolite imaging, where tumor heterogeneity requires high spatial resolution and the tracing of different metabolites requires spectral resolution. 56 As another limitation of the current study, the neural networkdesigned gradient waveforms may occasionally exceed the design limits, particularly in gradient strength and slew rate.…”

Section: Discussionmentioning

confidence: 99%

Multi‐task convolutional neural network‐based design of radio frequency pulse and the accompanying gradients for magnetic resonance imaging

Zhang

Jiang

et al. 2020

NMR in Biomedicine

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Modern MRI systems usually load the predesigned RFs and the accompanying gradients during clinical scans, with minimal adaption to the specific requirements of each scan. Here, we describe a neural network-based method for real-time design of excitation RF pulses and the accompanying gradients' waveforms to achieve spatially two-dimensional selectivity. Nine thousand sets of radio frequency (RF) and gradient waveforms with two-dimensional spatial selectivity were generated as the training dataset using the Shinnar-Le Roux (SLR) method. Neural networks were created and trained with five strategies (TS-1 to TS-5). The neural network-designed RF and gradients were compared with their SLR-designed counterparts and underwent Bloch simulation and phantom imaging to investigate their performances in spin manipulations. We demonstrate a convolutional neural network (TS-5) with multi-task learning to yield both the RF pulses and the accompanying two channels of gradient waveforms that comply with the SLR design, and these design results also provide excitation spatial profiles comparable with SLR pulses in both simulation (normalized root mean square error [NRMSE] of 0.0075 ± 0.0038 over the 400 sets of testing data between TS-5 and SLR) and phantom imaging. The output RF and gradient waveforms between the neural network and SLR methods were also compared, and the joint NRMSE, with both RF and the two channels of gradient waveforms considered, was 0.0098 ± 0.0024 between TS-5 and SLR. The RF and gradients were generated on a commercially available workstation, which took 130 ms for TS-5. In conclusion, we present a convolutional neural network with multi-task learning, trained with SLR transformation pairs, that is capable of simultaneously generating RF and two channels of gradient waveforms, given the desired spatially two-dimensional excitation profiles.

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Diagnostic Accuracy of High-Resolution Black-Blood MRI in the Evaluation of Intracranial Large-Vessel Arterial Occlusions

Cited by 33 publications

References 18 publications

Symptomatic Atherosclerotic Non-acute Intracranial Vertebral Artery Total Occlusion: Clinical Features, Imaging Characteristics, Endovascular Recanalization, and Follow-up Outcomes

Symptomatic Atherosclerotic Non-acute Intracranial Vertebral Artery Total Occlusion: Clinical Features, Imaging Characteristics, Endovascular Recanalization, and Follow-up Outcomes

Assessment of Intracranial Atherosclerotic Plaques Using 3D Black‐Blood MRI: Comparison With 3D Time‐of‐Flight MRA and DSA

Multi‐task convolutional neural network‐based design of radio frequency pulse and the accompanying gradients for magnetic resonance imaging

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