Intracranial Vessel Wall MRI: Principles and Expert Consensus Recommendations of the American Society of Neuroradiology

Mandell, Daniel M.; Mossa‐Basha, Mahmud; Qiao, Ye; Hess, Christopher P.; Hui, Ferdinand; Matouk, Charles; Johnson, Michele H.; Daemen, Mat J.A.P.; Vossough, Arastoo; Edjlali, Myriam; Saloner, David; Ansari, Sameer A.; Wasserman, Bruce A.; Mikulis, David J.

doi:10.3174/ajnr.a4893

Cited by 476 publications

(478 citation statements)

References 94 publications

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“…The solution currently available to clinicians heavily relies on luminography imaging, with which the stenotic degree is a primary criterion for defining a culprit or high‐risk lesion. However, extensive research on the atherosclerosis disease has suggested that lumen narrowing may not be a reliable indicator of plaque severity because of positive remodeling of the vessel wall,8 and the features exhibited directly by plaques may provide complementary information 9, 10…”

Section: Introductionmentioning

confidence: 99%

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Differential Features of Culprit Intracranial Atherosclerotic Lesions: A Whole‐Brain Vessel Wall Imaging Study in Patients With Acute Ischemic Stroke

Song

et al. 2018

JAHA

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BackgroundIntracranial atherosclerotic disease tends to affect multiple arterial segments. Using whole‐brain vessel wall imaging, we sought to study the differences in plaque features among various types of plaques in patients with a recent unilateral anterior circulation ischemic stroke.Methods and ResultsSixty‐one patients with unilateral anterior circulation ischemic stroke were referred to undergo whole‐brain vessel wall imaging (before and after contrast) within 1 month of symptom onset for intracranial atherosclerotic disease evaluations. Each plaque was classified as a culprit, probably culprit, or nonculprit lesion, according to its likelihood of causing the stroke. The associations between plaque features (thickening pattern, plaque‐wall contrast ratio, high signal on T1‐weighted images, plaque contrast enhancement ratio, enhancement grade, and enhancement pattern) and culprit lesions were estimated using mixed multivariable logistic regression after adjustment for maximum wall thickness. In 52 patients without motion corruption in whole‐brain vessel wall imaging, a total of 178 intracranial plaques in the anterior circulation were identified, including 52 culprit lesions (29.2%), 51 probably culprit lesions (28.7%), and 75 nonculprit lesions (42.1%). High signal on T1‐weighted images (adjusted odds ratio, 9.1; 95% confidence interval, 1.9–44.1; P=0.006), grade 2 (enhancement ratio of plaque ≥ enhancement ratio of pituitary) contrast enhancement (adjusted odds ratio, 17.4; 95% confidence interval, 1.8–164.9; P=0.013), and type 2 (≥50% cross‐sectional wall involvement) enhancement pattern (adjusted odds ratio, 10.1; 95% confidence interval, 1.3–82.2; P=0.030) were independently associated with culprit lesions.ConclusionsHigh signal on T1‐weighted images, grade 2 contrast enhancement, and type 2 enhancement pattern are associated with cerebrovascular ischemic events, which may provide valuable insights into risk stratification.

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Section: Introductionmentioning

confidence: 99%

“…Intracranial magnetic resonance (MR) vessel wall imaging (VWI) has emerged as a noninvasive modality for directly characterizing ICAD 10. The advent of 3‐dimensional VWI techniques in the past few years also makes it possible to simultaneously assess atherosclerotic plaques presenting in multiple arterial segments 11, 12.…”

Section: Introductionmentioning

confidence: 99%

Differential Features of Culprit Intracranial Atherosclerotic Lesions: A Whole‐Brain Vessel Wall Imaging Study in Patients With Acute Ischemic Stroke

Song

et al. 2018

JAHA

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“…Although intracranial VW imaging is still in its developmental stage, there are already several challenging diagnostic situations in which it has shown its potential value (1,2,60,61), the most important of which is determining the cause of stroke and assessing accompanying VW lesions. Recently, two excellent review papers have been published that both address the commonly found imaging characteristics of different types of intracranial VW disease, including a thorough literature overview (2,62).…”

Section: Vw Diseasementioning

confidence: 99%

“…The use of contrast material-enhanced MR imaging is considered a necessary component of VW imaging protocols (1,2). Sensitivity for contrast enhancement depends on optimal timing of contrast agent injection.…”

Section: Use Of Contrast Agentsmentioning

confidence: 99%

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The Use and Pitfalls of Intracranial Vessel Wall Imaging: How We Do It

et al. 2018

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Intracranial plaque with large lipid core is associated with embolic stroke of undetermined source

Tao

Wang

et al. 2023

Ann Clin Transl Neurol

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Objective To investigate an association between percentage lipid‐rich necrotic core (LRNC) and an index ischemic stroke in an embolic stroke of undetermined source (ESUS) cohort. Methods A total of 167 ESUS patients with 259 non‐stenotic intracranial plaques including 155 ipsilateral and 104 contralateral to stroke were finally enrolled in the current analysis. The multi‐dimensional parameters involving remodeling index (RI), plaque burden (PB), LRNC, discontinuity of plaque surface (DPS), intraplaque hemorrhage (IPH), and vulnerable plaque defined as presence of complicated plaque were evaluated by high‐resolution magnetic resonance imaging. Results We found that %LRNC was an independent predictor for ESUS in model 1 (OR: 2.574, 95% CI: 1.854–3.573, P < 0.001), and model 2 (OR: 2.550, 95% CI: 1.835–3.545, P < 0.001), but the association was not seen in PB. In receiver operating characteristic curve analysis, the discrimination of LRNC for ESUS was significantly superior to that of PB (absolute difference: 0.121, 95% CI: 0.056–0.205, P < 0.001). Importantly, a significantly positive synergy between the remodeling pattern and LRNC in response to plaque vulnerability was found by Sankey diagram (P for interaction = 0.001). Conclusion This is the first report that LRNC, beyond PB, may be correlated with an index ESUS, and a synergistic effect between positive remodeling and larger LRNC could promote plaque vulnerability. The findings suggest that a potential target subgroup may benefit from stroke prevention with intensive statin, although this must be confirmed in future.

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Intracranial Vessel Wall MRI: Principles and Expert Consensus Recommendations of the American Society of Neuroradiology

Cited by 476 publications

References 94 publications

Differential Features of Culprit Intracranial Atherosclerotic Lesions: A Whole‐Brain Vessel Wall Imaging Study in Patients With Acute Ischemic Stroke

Differential Features of Culprit Intracranial Atherosclerotic Lesions: A Whole‐Brain Vessel Wall Imaging Study in Patients With Acute Ischemic Stroke

The Use and Pitfalls of Intracranial Vessel Wall Imaging: How We Do It

Intracranial plaque with large lipid core is associated with embolic stroke of undetermined source

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