Hyperintense Plaque on Intracranial Vessel Wall Magnetic Resonance Imaging as a Predictor of Artery-to-Artery Embolic Infarction

Wu, Fang; Song, Haiqing; Ma, Qingfeng; Xiao, Jiayu; Jiang, Tao; Huang, Xiaoqin; Bi, Xiaoming; Guo, Xin; Li, Debiao; Yang, Qi; Ji, Xunming; Fan, Zhaoyang

doi:10.1161/strokeaha.117.020046

Cited by 70 publications

(58 citation statements)

References 33 publications

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“…In all studies, vessel-wall MRI was prospectively acquired from ICAS or stroke cohorts and was analyzed retrospectively. Fourteen (2, 6, 13–16, 18, 19, 22, 24, 25, 27, 28, 30) and three studies (23, 26, 29) enrolled only middle cerebral artery (MCA) plaques (one study including 7% internal carotid artery (ICA) plaques was enrolled) and only basilar artery (BA) plaques in accordance with their inclusion criteria, respectively, and three studies (17, 20, 21) enrolled both large- and medium-size intracranial arteries for their subjects. The proportion of MCA lesions and BA lesions to total lesions were 74.1%, 25.9%, respectively (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Vessel-Wall Magnetic Resonance Imaging of Intracranial Atherosclerotic Plaque and Ischemic Stroke: A Systematic Review and Meta-Analysis

2018

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Introduction: Vessel-wall magnetic resonance imaging (MRI) has been suggested as a valuable tool for assessing intracranial arterial stenosis with additional diagnostic features. However, there is limited conclusive evidence on whether vessel-wall MR imaging of intracranial atherosclerotic plaques provides valuable information for predicting vulnerable lesions. We conducted this systematic review and meta-analysis to evaluate which characteristics of intracranial-plaque on vessel-wall MRI are markers of culprit lesions.Methods: The MEDLINE, EMBASE, and Cochrane Library of Clinical Trials databases were searched for studies reporting the association between vessel-wall MRI characteristics of intracranial plaque and corresponding stroke events. Odds ratios (ORs) for the prevalence of stroke with intracranial-plaque MRI characteristics were pooled in a meta-analysis using a random-effects model.Results: Twenty studies were included in this review. We found a significant association between plaque enhancement (OR, 10.09; 95% CI, 5.38–18.93), positive remodeling (OR, 6.19; 95% CI, 3.22–11.92), and plaque surface irregularity (OR, 3.94; 95% CI, 1.90–8.16) with stroke events. However, no significant difference was found for the presence of eccentricity (OR, 1.22; 95% CI, 0.51–2.91).Conclusion: Based on current evidence, intracranial plaque contrast enhancement, positive remodeling, and plaque irregularity on MRI are associated with increased risk of stroke events. Our findings support the design of future studies on intracranial-plaque MRI and decision making for the management of intracranial atherosclerotic plaques.

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Section: Resultsmentioning

confidence: 99%

Vessel-Wall Magnetic Resonance Imaging of Intracranial Atherosclerotic Plaque and Ischemic Stroke: A Systematic Review and Meta-Analysis

2018

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“…Currently, some studies have focused on the relationship between the degree of intracranial arterial PE and ISEs. Some of which has shown strong correlations between PE and ISEs (13, 14, 16, 24, 25). Unfortunately, most of these studies have only included more than 50% of arterial stenosis, which is one of the mechanisms of acute ISEs, moreover, without the simultaneous analysis of the correlations between the degree of arterial stenosis and acute ISEs.…”

Section: Discussionmentioning

confidence: 99%

A High-Resolution MRI Study of the Relationship Between Plaque Enhancement and Ischemic Stroke Events in Patients With Intracranial Atherosclerotic Stenosis

Wang

Shao²,

et al. 2019

Front. Neurol.

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Purpose: To investigate the relationships among the degree of intracranial atherosclerotic stenosis (ICAS), plaque enhancement (PE), and ischemic stroke events (ISEs) using 3. 0 T high-resolution magnetic resonance imaging (HR-MRI).Materials and Methods: Fifty-two ICAS patients who underwent HR-MRI were retrospectively analyzed. The patients were divided into two groups according to the results of whole-brain digital subtraction angiography (DSA): the mild-moderate stenosis group (group MID) and the severe stenosis group (group SEV). According to the onset time of the ISEs, the plaques were divided into the acute/sub-acute phase culprit plaque group (group ACU, within 1 month), the chronic-phase culprit plaque group (group CHR, more than 1 month), and the non-culprit plaque group (group NON). Two neuroradiologists independently measured the signal intensity of PE and pituitary enhancement in the HR-MRI and calculated the ratio of the two indices. According to the ratio, the patients were divided into three groups: the marked enhancement group (group MA), the mild enhancement group (group ME), and the no enhancement plaque group (group NO). The relationships among the degree of ICAS, the degree of PE and ISEs were analyzed.Results: Seventy-two ICAS plaques were identified in 52 patients. The multiple independent samples Kruskal-Wallis H test showed that the differences among group ACU, CHR, and NON were significant in the degree of PE (P = 0.002). Group CHR and group NON were combined as the non-acute phase group (group non-ACU). Group NO and group ME were combined as the non-marked enhancement group (group non-MA). The comparison between group ACU and group non-ACU showed significant differences in the degree of both ICAS (P = 0.014) and PE (P = 0.006) according to the univariate logistic regression. The multivariate logistic regression model was used to analyze the impact of the degree of ICAS and PE on ISEs, and the results showed that severe stenosis (P = 0.036) and marked PE (P = 0.013) were independent risk factors for acute ISEs, respectively.Conclusion: Severe intracranial arterial stenosis and marked plaque enhancement are independent risk factors for acute ischemic stroke events, respectively. The study provides new ideas for further exploring the pathogenesis of stroke caused by intracranial atherosclerotic stenosis.

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“…Moreover, in cases such as artery-to-artery embolism within the intracranial arterial vasculature, timing may be key to detecting enhancing culprit lesions with plaque surface irregularity. 8 As a future direction, it would be informative to examine the importance of the timing of VW-MR imaging to address its impact in acute primary treatment decisions, which, in turn, would also address secondary prevention.…”

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confidence: 99%

Impact of Vessel Wall MR Imaging in the Work-Up for Ischemic Stroke

Song

2019

AJNR Am J Neuroradiol

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Hyperintense Plaque on Intracranial Vessel Wall Magnetic Resonance Imaging as a Predictor of Artery-to-Artery Embolic Infarction

Abstract: A-to-A embolic infarction has distinct vulnerable plaque characteristics compared with non-A-to-A embolic infarction. HIP and plaque surface irregularity may predict A-to-A embolic infarction.

Cited by 70 publications

References 33 publications

Vessel-Wall Magnetic Resonance Imaging of Intracranial Atherosclerotic Plaque and Ischemic Stroke: A Systematic Review and Meta-Analysis

Vessel-Wall Magnetic Resonance Imaging of Intracranial Atherosclerotic Plaque and Ischemic Stroke: A Systematic Review and Meta-Analysis

A High-Resolution MRI Study of the Relationship Between Plaque Enhancement and Ischemic Stroke Events in Patients With Intracranial Atherosclerotic Stenosis

Impact of Vessel Wall MR Imaging in the Work-Up for Ischemic Stroke

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