High-resolution MR vessel wall imaging in determining the stroke aetiology and risk stratification in isolated middle cerebral artery disease

Tandon, Vaibhav; Senthilvelan, Santhakumar; Sreedharan, Sapna Erat; Kesavadas, Chandrasekharan; Vt, Jissa; Sylaja, PN

doi:10.1007/s00234-021-02891-9

Cited by 4 publications

(7 citation statements)

References 25 publications

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“…The HR-VWI changes of the isolated stenosis artery can help to identify SV. 2 The follow-up findings of our case demonstrated that HR-VWI showed a significant reduction in the degree of wall thickening and stenosis and the enhancement after anti-syphilis treatment with antiplatelet drugs. CNS vasculitis cannot be treated without steroids or immunosuppression treatment.…”

Section: Discussionsupporting

confidence: 55%

“…High-resolution vessel wall magnetic resonance imaging (HR-VWI) has been successfully employed in the characterisation of intracranial vessel wall pathology. 2 HR-VWI does not not only allow wall and lumen imaging, but also provides important information in the structure of vessel wall to hint the causes of vascular stenosis. We reported a case with cerebral infarction and isolated middle cerebral artery stenosis caused by SV and followed up the HR-VWI changes after anti-syphilis treatment.…”

Section: Introductionmentioning

confidence: 99%

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Isolated middle cerebral artery stenosis caused by syphilitic vasculitis

Zhang

Chen

et al. 2022

Sex. Health

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Background. Syphilitic vasculitis (SV) is rare and difficult to be diagnosed. High-resolution vessel wall magnetic resonance imaging (HR-VWI) might be valuable in the diagnosis by differentiating SV from other vessel wall pathologies. Methods. We report a rare case with severe isolated middle cerebral artery (MCA) stenosis and cerebral infarction, which was evaluated by serial HR-VWI. Results. A 46-year-old woman presented with an acute infarct in the left basal ganglia and severe isolated stenosis in left middle cerebral artery (MCA). Cerebrospinal fluid (CSF) analysis was performed and the findings were consistent with neurosyphilis diagnosis. The MCA stenosis was also suspected to be the result of SV. HR-VWI revealed the evidence of concentric thickening and circular uniform enhancement of the arterial wall. After two cycles of antisyphilis treatment, subsequent HR-VWI showed that the MCA stenosis was reduced significantly except slight enhancement of the arterial wall, which confirmed that the SV caused the isolated MCA stenosis. Conclusions. HR-VWI could be an important diagnostic tool for isolated middle cerebral artery stenosis caused by SV, which could serve as a biomarker for assessing the response to anti-syphilis treatment in the future.

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Section: Discussionsupporting

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Isolated middle cerebral artery stenosis caused by syphilitic vasculitis

Zhang

Chen

et al. 2022

Sex. Health

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“…Song et al reported that VW-MRI changed etiologic classification, resulting in a higher percentage of cases reclassified as intracranial atherosclerotic disease [ 51 ]. VW-MRI can significantly improve diagnostic differentiation of intracranial vascular disorders compared with luminal imaging alone [ 51 , 53 , 54 ].…”

Section: Clinical Application Of Vw-mri—arterial Diseasesmentioning

confidence: 99%

Vessel wall MR imaging in neuroradiology

et al. 2022

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Vessel wall MR imaging (VW-MRI) has been introduced into clinical practice and applied to a variety of diseases, and its usefulness has been reported. High-resolution VW-MRI is essential in the diagnostic workup and provides more information than other routine MR imaging protocols. VW-MRI is useful in assessing lesion location, morphology, and severity. Additional information, such as vessel wall enhancement, which is useful in the differential diagnosis of atherosclerotic disease and vasculitis could be assessed by this special imaging technique. This review describes the VW-MRI technique and its clinical applications in arterial disease, venous disease, vasculitis, and leptomeningeal disease.

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“…21,22 Finally, the follow-up period in most studies is limited, and therefore the prognostic significance of enhancement as a predictor of long-term clinical recurrence in ICAD patients is largely unknown. 13,18,21,23 In this context, we designed a prospective, multicentric, and longterm longitudinal study, aiming to evaluate whether postcontrast enhancement of the intracranial atherosclerotic plaque predicts longterm future strokes in symptomatic and asymptomatic ICAD patients of Caucasian ancestry.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, most of the studies performed so far were single‐center, so whether the parameter enhancement is ready to be applied in multicenter real clinical practice remains to be clarified 21,22 . Finally, the follow‐up period in most studies is limited, and therefore the prognostic significance of enhancement as a predictor of long‐term clinical recurrence in ICAD patients is largely unknown 13,18,21,23 …”

Section: Introductionmentioning

confidence: 99%

Intracranial atherosclerotic plaque enhancement and long‐term risk of future strokes: A prospective, longitudinal study

Gómez‐Vicente

Hernández‐Pérez

Martínez‐Velasco

et al. 2022

Journal of Neuroimaging

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Background and Purpose The prognostic significance of postcontrast enhancement of intracranial atheromatous plaque is uncertain. Prospective, long‐term follow‐up studies in Caucasians, using a multicenter design, are lacking. We aimed to evaluate whether this radiological sign predicts long‐term new stroke in symptomatic and asymptomatic intracranial atherosclerotic disease (ICAD) patients. Methods This was a prospective, observational, longitudinal, multicenter study. We included a symptomatic and an asymptomatic cohort of ICAD patients that underwent 3T MRI including high‐resolution sequences focused on the atheromatous plaque. We evaluated grade of stenosis, plaque characteristics, and gadolinium enhancement ratio (postcontrast plaque signal/postcontrast corpus callosum signal). The occurrence of new events was evaluated at 3, 6, 9, and 12 months and annually thereafter. The association between plaque characteristics and new stroke was studied using Cox multiple regression survival analysis and Kaplan‐Meier curves. Results Forty‐eight symptomatic and 13 asymptomatic patients were included. During 56.3 ± 16.9 months, 11 patients (18%) suffered a new event (seven ischemic, two hemorrhagic, and two transient ischemic attacks). A receiver operating characteristic curve identified an enhancement ratio of >1.77 to predict a new event. In a multivariable Cox regression, postcontrast enhancement ratio >1.77 (hazard ratio [HR]= 3.632; 95% confidence interval [CI], 1.082‐12.101) and cerebral microbleeds (HR = 5.244; 95% CI, 1.476‐18.629) were independent predictors of future strokes. Patients with a plaque enhancement ratio >1.77 had a lower survival free of events (p < .05). Conclusions High intracranial postcontrast enhancement is a long‐term predictor of new stroke in ICAD patients. Further studies are needed to elucidate whether postcontrast enhancement reflects inflammatory activity of intracranial atheromatous plaque.

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High-resolution MR vessel wall imaging in determining the stroke aetiology and risk stratification in isolated middle cerebral artery disease

Cited by 4 publications

References 25 publications

Isolated middle cerebral artery stenosis caused by syphilitic vasculitis

Isolated middle cerebral artery stenosis caused by syphilitic vasculitis

Vessel wall MR imaging in neuroradiology

Intracranial atherosclerotic plaque enhancement and long‐term risk of future strokes: A prospective, longitudinal study

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