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

Song, Jae Woo

doi:10.3174/ajnr.a6241

Cited by 4 publications

(5 citation statements)

References 11 publications

(9 reference statements)

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“…In the adult stroke population, several studies have already tested the utility of intracranial high-resolution VW MRI in differentiating intracranial vasculopathic diseases causing stroke (49)(50)(51)(52). Yet, the diagnostic utility of VW-MRI in the work-up of ischemic stroke still remains a subject of debate, namely on its impact regarding patient outcomes (53). Kesav et al (49) reported a large number of stroke etiology reclassification due to the use of VW-MRI in cases originally classified as "undetermined" etiologies.…”

Section: In Adultsmentioning

confidence: 99%

Vessel wall MR imaging for the detection of intracranial inflammatory vasculopathies

Edjlali¹,

Qiao²,

Boulouis³

et al. 2020

Cardiovasc Diagn Ther

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Intracranial vasculopathies are routinely investigated by lumen-based modalities such as magnetic resonance angiography (MRA), computed tomography angiography (CTA), and digital subtraction angiography (DSA). These techniques are useful to analyze the vessel lumen, allowing to detect vessel stenosis or occlusion. However, the primum movins of the disease, i.e., an abnormal thickening of the vessel wall, remains within the arterial wall. The vasculopathy can moreover be present without always narrowing the lumen or modifying its regularity. Hence, there is a need to detect directly and analyze vessel wall abnormalities. Development of 3D high-resolution black blood sequences for intracranial vessel wall MR imaging (VW-MRI) enabled routine clinical applications not only vasculitis, but also of intracranial atherosclerotic disease (ICAD), intracranial dissections, reversible intracranial dissections, reversible cerebral vasoconstriction syndrome (RCVS), Moyamoya disease, and intracranial aneurysms. This highresolution intracranial VW-MRI approach is increasingly used on a clinical basis at many centers to solve diagnostic problems, especially in patients with ischemic stroke or intracranial hemorrhage. An expert consensus Guideline from the American Society of Neuroradiology provides recommendations for clinical implementation of intracranial vessel wall MRI. There are several technical aspects needed to be considered when implementing VW-MRI in intracranial vessels, including flow suppression, both in blood and cerebrospinal fluid (CSF), spatial resolution and signal-to-noise ratio (SNR). In this article, we review the technical aspects of VW-MRI, and recommend applications for vascular diseases including non-occlusive intracranial vasculopathies, Moyamoya disease, and identifying culprit plaques. We also give a focus on the utility of VW-MRI for determining stroke etiology in adults and in children and young adults.

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Section: In Adultsmentioning

confidence: 99%

Vessel wall MR imaging for the detection of intracranial inflammatory vasculopathies

Edjlali¹,

Qiao²,

Boulouis³

et al. 2020

Cardiovasc Diagn Ther

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“…Compared to conventional arterial imaging techniques such as CTA, MRA, or TFCA, which focus on the arterial lumen, VW-MRI visualizes the arterial wall, directly identifying pathologic changes. Because blackblood T1WI before and after intravenous gadolinium contrast can show the vessel wall directly, it is a useful adjunct to conventional imaging for differentiating the causes of intracranial arteriopathy [21]. It also plays an important role in clarifying the etiology of ischemic stroke or transient ischemic attack [22].…”

Section: Discussionmentioning

confidence: 99%

The Value of High-Resolution Vessel Wall Magnetic Resonance Imaging in the Diagnosis and Management of Primary Angiitis of the Central Nervous System in Children

et al. 2021

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High-resolution vessel wall-magnetic resonance imaging (VW-MRI) has been used to detect regional vessel wall pathology, significantly contributing to the diagnosis of primary angiitis of the central nervous system (PACNS) from other arteriopathies. In this study, we aimed to describe three cases of PACNS initially presenting as acute ischemic stroke, diagnosed and followed up with VW-MRI. Methods: The medical records of three patients diagnosed with PACNS were retrospectively reviewed. We also reviewed the clinical application of VW-MRI in published articles for the pediatric cases since 2016. Results: The initial presenting symptoms were headache, diplopia, confused mentality, hemiplegia, dysarthria, and dizziness. All patients had acute infarction on brain MRI, with suspicion of vasculopathy on magnetic resonance angiography. VW-MRI revealed narrowing of vessels with concentric wall thickening and diffuse enhancement in the anterior cerebral artery (n=1), middle cerebral artery (n=1), posterior cerebral artery (n=2), lenticulostriate artery (n=1), anterior inferior cerebellar artery (n=1), and vertebral artery (n=1), suggestive of vascular wall pathology. After excluding the possible etiologies of vasculitis, the clinical diagnosis of PACNS was established. Three patients received high-dose steroid and cyclophosphamide therapy. Two patients were treated with long-term azathioprine based upon the findings of persistent vessel enhancement on VW-MRI. All patients were regularly followed up with VW-MRI for more than 1 year. We summarized the clinical and radiological features of the published pediatric cases using VW-MRI to date. Conclusion: High-resolution VW-MRI plays an important role in diagnosing childhood PACNS, as results correlate with disease activity.

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“…VW-MRI has provided supplemental information to luminal imaging [ 51 ], but diagnostic utility of VW-MRI in the work-up of ischemic stroke has also been reported. Kesav et al reported that VW-MRI reclassified etiology and influenced diagnostic evaluation in cases originally classified as “undetermined” etiologies and large (intracranial) artery atherosclerosis [ 52 ].…”

Section: Clinical Application Of Vw-mri—arterial Diseasesmentioning

confidence: 99%

“…Kesav et al reported that VW-MRI reclassified etiology and influenced diagnostic evaluation in cases originally classified as “undetermined” etiologies and large (intracranial) artery atherosclerosis [ 52 ]. 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%

“…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%

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

Cited by 4 publications

References 11 publications

Vessel wall MR imaging for the detection of intracranial inflammatory vasculopathies

Vessel wall MR imaging for the detection of intracranial inflammatory vasculopathies

The Value of High-Resolution Vessel Wall Magnetic Resonance Imaging in the Diagnosis and Management of Primary Angiitis of the Central Nervous System in Children

Vessel wall MR imaging in neuroradiology

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