Disparate trends of atherosclerotic plaque evolution in stroke patients under 18-month follow-up: a 3D whole-brain magnetic resonance vessel wall imaging study

Abstract

Purpose The trend of atherosclerotic plaque feature evolution is unclear in stroke patients with and without recurrence. We aimed to use three-dimensional whole-brain magnetic resonance vessel wall imaging to quantify the morphological changes of causative lesions during medical therapy in patients with symptomatic intracranial atherosclerotic disease. Methods Patients with acute ischemic stroke attributed to intracranial atherosclerotic disease were retrospectively enrolled if they underwent both baseline and follow-up magnetic resonance vessel wall imaging. The morphological features of the causative plaque, including plaque volume, peak normalized wall index, maximum wall thickness, degree of stenosis, pre-contrast plaque-wall contrast ratio, and post-contrast plaque enhancement ratio, were quantified and compared between the non-recurrent and recurrent groups (defined as the recurrence of a vascular event within 18 months of stroke). Results Twenty-nine patients were included in the final analysis. No significant differences were found in plaque features in the baseline scan between the non-recurrent ( n = 22) and recurrent groups ( n = 7). The changes in maximum wall thickness (–13.32% vs. 8.93%, P = 0.026), plaque-wall contrast ratio (–0.82% vs. 3.42%, P = 0.005) and plaque enhancement ratio (–11.03% vs. 9.75%, P = 0.019) were significantly different between the non-recurrent and recurrent groups. Univariable logistic regression showed that the increase in plaque-wall contrast ratio (odds ratio 3.22, 95% confidence interval 1.55–9.98, P = 0.003) was related to stroke recurrence. Conclusion Morphological changes of plaque features on magnetic resonance vessel wall imaging demonstrated distinct trends in symptomatic intracranial atherosclerotic disease patients with and without stroke recurrence.

Radiomics Nomogram for Predicting Stroke Recurrence in Symptomatic Intracranial Atherosclerotic Stenosis

“…Plaque enhancement ratio and plaque burden have been previously shown to be significantly associated with stroke recurrence in SICAS (Ran et al, 2020 ; Shi et al, 2020 ; Xiao et al, 2022 ). Plaque enhancement, a characteristic of vulnerable plaque, is related to plaque inflammation, neovascularization, and vascular endothelial permeability (Moulton et al, 2003 ; Marnane et al, 2012 ; Millon et al, 2012 ; Qiao et al, 2014 ).…”

Case Report: Serial MR Vessel Wall Imaging Visualizes the Response of Intracranial Plaques and Assists in Decision-Making

“…In this representative case, our findings highly suggest that serial MR-VWI may early detect lesion-level response or resistance during medical treatment, and this information can be supplemental to routine assessments such as laboratory test in guiding treatment plans. A treatment plan may be modified in a timely manner to better achieve secondary stroke prevention (Xiao et al, 2021 ). Of course, large-scale clinical trials are warranted to validate this hypothesis.…”

“…prevention (Xiao et al, 2021). Of course, large-scale clinical trials are warranted to validate this hypothesis.…”

Intracranial vessel wall segmentation with deep learning using a novel tiered loss function incorporating class inclusion

“…Quantitative assessment of atherosclerotic lesions based on MR‐VWI may provide valuable insights into the severity of ICAD 4 . Several morphological measurements, such as normalized wall index (NWI), arterial wall remodeling ratio, and plaque‐to‐wall contrast ratio, have been shown to be useful imaging surrogates for plaque burden quantification 5–9 . These measurements rely on accurate contouring of the vessel wall in a cross‐sectional view.…”