Magnetic Resonance Imaging of Plaque Morphology, Burden, and Distribution in Patients With Symptomatic Middle Cerebral Artery Stenosis

Dieleman, Nikki; Yang, Wei; Abrigo, Jill; Chu, Winnie C.W.; Kolk, Anja G. van der; Siero, Jeroen C.W.; Wong, Ka Sing; Hendrikse, Jeroen; Chen, Xiang Yan

doi:10.1161/strokeaha.116.013007

Cited by 69 publications

(64 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This suggests that type 2 thickening pattern may be a marker of more progressive and extensive plaques, which may easily develop into vulnerable plaques. This finding is in line with a previous study, in which the authors found that asymptomatic lesions were associated with eccentric plaques, but symptomatic lesions were both eccentric and concentric 7. However, their study included most patients with chronic stroke, which failed to accurately reflect the association between plaque features and acute stroke.…”

Section: Discussionsupporting

confidence: 90%

“…Also, a postmortem study found that neovascularity in intracranial atherosclerotic plaque is associated with infarct 28. Several studies of intracranial VWI have reported that plaque enhancement is associated with acute, subacute, and even chronic infarction 7, 15, 17, 29, 30. We found that strong contrast enhancement (grade 2) was associated with culprit lesions, likely suggesting greater neovascularization and/or inflammation activities in those lesions.…”

Section: Discussionsupporting

confidence: 55%

“…ICAD tends to affect multiple arterial segments 6. Despite the same genetic milieu and acquired factors, the coexisting atherosclerotic plaques in a given patient exhibit different outcomes; some lesions become symptomatic, whereas others remain asymptomatic 7. This fact brings 2 critical challenges in the management of patients with ICAD: the identification of the symptomatic or culprit lesion in symptomatic patients and the identification of the vulnerable (or high risk for causing a stroke) plaque in asymptomatic patients.…”

Section: Introductionmentioning

confidence: 99%

“…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. Using VWI, several plaque features have been intimately associated with symptomatic or asymptomatic lesions, such as high signal on T1‐weighted images (HST1), wall thickening pattern, and postcontrast enhancement 7, 13, 14, 15, 16, 17, 18. However, most of previous studies were limited to one feature only, a local arterial segment, or a cohort with heterogeneous time periods after symptom onset.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

show abstract

“…45 Another study including symptomatic significant MCA stenosis showed that plaques with non-significant luminal narrowing was associated with eccentricity (p<0.05). 40 Therefore, the analysis of the …”

Section: Assessment Of Carotid Plaque Burden Using Ultrasonographymentioning

confidence: 99%

Diagnostic and Therapeutic Approach of Carotid and Cerebrovascular Plaque on the Basis of Vessel Imaging

Lee

Park

2017

J Lipid Atheroscler

View full text Add to dashboard Cite

Atherosclerosis, characterized by chronic systemic inflammation with plaque formation, is one of the major causes of cerebrovascular disease. Recent advances in imaging technologies can help further understand the overall process and biology of plaque formation and rupture. Thus, these imaging techniques could aid clinicians to make better decision for risk stratification, therapeutic planning, and prediction of future cerebrovascular event. Ultrasonography, magnetic resonance imaging, and positron emission tomography are the rapidly-evolving imaging modalities dealing with assessment of atherosclerotic plaque. By advances in imaging technology for evaluating plaque, we can characterize the vulnerability of plaque in-vivo, understand the composition and activity of plaque, assess therapeutic response to treatment, and ultimately predict the overall risk of future cerebrovascular episodes. In this review, we will introduce current understanding of various advanced imaging modalities and clinical application of these imaging technologies. (J Lipid Atheroscler 2017 June;6(1):15-21)

show abstract

A comparison of contrast transthoracic echocardiography and contrast transcranial Doppler in cryptogenic stroke patients with patent foramen ovale

Chen

et al. 2019

Brain and Behavior

View full text Add to dashboard Cite

Objective In recent years, increasing attention has been paid to cryptogenic stroke (CS) caused by the patent foramen ovale (PFO). This study aims to compare contrast transthoracic echocardiography (cTTE) and contrast transcranial Doppler (cTCD) to determine whether cTTE is more suitable and reliable than cTCD for clinical use. Methods From March 2017 to May 2018, patients who suffered from migraines, stroke, hypomnesis, or asymptomatic stroke found casually were included in our study. Patients with CS were semirandomly divided into two groups (cTTE and cTCD) according to the date of the outpatient visit. Patients with either of the examination above found positive were selected to finish transesophageal echocardiography (TEE). Results In our study, the sensitivities of group cTTE positive (group cTTE+) and group cTCD positive (group cTCD+) did not have any statistical difference (89% vs. 80%, p = 0.236). Focusing on group cTCD+, we discovered that the semiquantitative shunt grading was not correlated with whether a PFO was present or not ( p = 0.194). However, once the PFO has been diagnosed, the shunt grading was shown to be related to the width of the gaps ( p = 0.032, p deviation = 0.03). Conclusion Both cTTE and the cTCD can be used for preliminary PFO findings. The semiquantitative shunt grading of cTCD and cTTE can suggest the size of the PFO and the next course of treatment. The cTTE may be more significant to a safe PFO (a PFO does not have right‐to‐left shunts, RLSs). Combining cTTE and TEE could help diagnose PFO and assess CS risk.

show abstract

Magnetic Resonance Imaging of Plaque Morphology, Burden, and Distribution in Patients With Symptomatic Middle Cerebral Artery Stenosis

Abstract: Supplemental Digital Content is available in the text.

Cited by 69 publications

References 39 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

Diagnostic and Therapeutic Approach of Carotid and Cerebrovascular Plaque on the Basis of Vessel Imaging

A comparison of contrast transthoracic echocardiography and contrast transcranial Doppler in cryptogenic stroke patients with patent foramen ovale

Contact Info

Product

Resources

About