Intracranial arterial wall imaging: Techniques, clinical applicability, and future perspectives

Abstract

Purpose To review the current state of the art and future development of intracranial vessel wall imaging. Methods Recent literature review and expert opinion about intracranial arterial wall imaging. Results Intracranial large artery diseases represent an important cause of stroke and vascular cognitive impairment worldwide. Our traditional understanding of intracranial large artery diseases is based on the observation of luminal narrowing or occlusion with angiographic or ultrasound techniques. Recently, novel imaging techniques have made the intracranial artery wall accessible for noninvasive visualization. The main advantage of vessel-wall imaging as compared to conventional imaging techniques for visualization of intracranial arteries is the ability to detect vessel wall changes even before they get to cause any significant luminal stenosis. This diagnostic capacity is provoking a revolutionary change in the way we see the intracranial circulation. In this article, we will review the current state of magnetic resonance imaging and computed tomography-based intracranial arterial wall imaging, focusing on technical considerations and their clinical applicability. Moreover, we will provide the readers with our vision on the future development of vessel-wall imaging techniques. Conclusion Intracranial arterial wall imaging methods are gaining increasing potential to impact the diagnosis and treatment of patients with cerebrovascular diseases.

The relationship between vertebrobasilar artery calcification and intracranial atherosclerosis-related occlusion in thrombectomy

“…Apart from precipitated calcium deposits in necrotic tissue, calcifications may have “bone-like” structures driven by hematopoietic cells ( 20 ), thereby appearing as high densities on CT scans along the artery. Furthermore, previous studies have suggested VBAC as associated with intracranial atherosclerosis ( 13 , 14 ).…”

“…At present, there is no imaging method to quickly determine the type of occlusion (8, b). Vertebrobasilar artery calcification (VBAC) on non-contrast computed tomography (NCCT) is widely used to visualize and represent intracranial atherosclerosis ( 13 , 14 ). Therefore, this study was designed to investigate the relationship between VBAC and ICAS-O in order to potentially quickly determine the types of occlusions.…”

Qualitative Assessment and Reporting Quality of Intracranial Vessel Wall MR Imaging Studies: A Systematic Review

“…ABBREVIATIONS: CRS 4 complete reporting score; ICAD 4 intracranial atherosclerotic disease; STROBE 4 Strengthening the Reporting of Observational Studies in Epidemiology; VWI 4 vessel wall MR imaging V essel wall MR imaging (VWI) is being increasingly used worldwide to evaluate intracranial vasculopathies. 1 This increased utilization has paralleled a rise in the number of publications using VWI. Many narrative reviews report the application and utility of VWI for different types of vasculopathies.…”

European Stroke Organisation guidelines on treatment of patients with intracranial atherosclerotic disease

“…The clinical context is of critical importance to perform a differential diagnosis with other intracranial arteriopathies, such as infectious or noninfectious vasculitis, intracranial dissection, reversible cerebral vasoconstriction, or arterial vasospasm. In this setting, high-resolution arterial-wall MRI is gaining importance in the characterization of intracranial atherosclerotic plaques and their distinction from other causes of intracranial stenosis 15,16 Finally, we will categorize ICAD as symptomatic or asymptomatic, depending on whether a cerebral ischemic event can be attributed to the intracranial atherosclerotic plaque or not. Asymptomatic ICAD can be found in stroke-free individuals, but also in stroke patients in whom another known entity is acting as the probable cause of the acute cerebral ischemia, or also when ICAD is affecting several intracranial arteries, with coexistence of one symptomatic intracranial atherostenosis and one or more asymptomatic atherostenoses.…”