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Cogswell PM, Davis TL, Strother MK, Faraco CC, Scott AO, Jordan LC, Fusco MR, Frederick BD, Hendrikse J, Donahue MJ. Impact of vessel wall lesions and vascular stenoses on cerebrovascular reactivity in patients with intracranial stenotic disease. J Magn Reson Imaging 2017; 46:1167-1176. [PMID: 28061015 DOI: 10.1002/jmri.25602] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/06/2016] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To compare cerebrovascular reactivity (CVR) and CVR lagtimes in flow territories perfused by vessels with vs. without proximal arterial wall disease and/or stenosis, separately in patients with atherosclerotic and nonatherosclerotic (moyamoya) intracranial stenosis. MATERIALS AND METHODS Atherosclerotic and moyamoya patients with >50% intracranial stenosis and <70% cervical stenosis underwent angiography, vessel wall imaging (VWI), and CVR-weighted imaging (n = 36; vessel segments evaluated = 396). Angiography and VWI were evaluated for stenosis locations and vessel wall lesions. Maximum CVR and CVR lagtime were contrasted between vascular territories with and without proximal intracranial vessel wall lesions and stenosis, and a Wilcoxon rank-sum was test used to determine differences (criteria: corrected two-sided P < 0.05). RESULTS CVR lagtime was prolonged in territories with vs. without a proximal vessel wall lesion or stenosis for both patient groups: moyamoya (CVR lagtime = 45.5 sec ± 14.2 sec vs. 35.7 sec ± 9.7 sec, P < 0.001) and atherosclerosis (CVR lagtime = 38.2 sec ± 9.1 sec vs. 35.0 sec ± 7.2 sec, P = 0.001). For reactivity, a significant decrease in maximum CVR in the moyamoya group only (maximum CVR = 9.8 ± 2.2 vs. 12.0 ± 2.4, P < 0.001) was observed. CONCLUSION Arterial vessel wall lesions detected on noninvasive, noncontrast intracranial VWI in patients with intracranial stenosis correlate on average with tissue-level impairment on CVR-weighted imaging. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1167-1176.
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Affiliation(s)
- Petrice M Cogswell
- Department of Radiology, Vanderbilt University, Nashville, Tennessee, USA
| | - Taylor L Davis
- Department of Radiology, Vanderbilt University, Nashville, Tennessee, USA
| | | | - Carlos C Faraco
- Department of Radiology, Vanderbilt University, Nashville, Tennessee, USA
| | - Allison O Scott
- Department of Radiology, Vanderbilt University, Nashville, Tennessee, USA
| | - Lori C Jordan
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA.,Department of Neurology, Vanderbilt University, Nashville, Tennessee, USA
| | - Matthew R Fusco
- Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee, USA
| | | | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Manus J Donahue
- Department of Radiology, Vanderbilt University, Nashville, Tennessee, USA.,Department of Neurology, Vanderbilt University, Nashville, Tennessee, USA.,Department of Psychiatry, Vanderbilt University, Nashville, Tennessee, USA
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152
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Yu LB, Zhang Q, Shi ZY, Wang MQ, Zhang D. High-resolution Magnetic Resonance Imaging of Moyamoya Disease. Chin Med J (Engl) 2016; 128:3231-7. [PMID: 26612300 PMCID: PMC4794888 DOI: 10.4103/0366-6999.170257] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To introduce the imaging characteristics of moyamoya disease (MMD) using high-resolution magnetic resonance imaging (HR-MRI) and to discuss the role of HR-MRI in differentiating MMD from other intracranial artery diseases, especially intracranial atherosclerotic disease (ICAD). Data Sources: This review was based on the data in articles published between 2005 and 2015, which were obtained from PubMed. The keywords included HR-MRI, MMD, ICAD, and intracranial artery diseases. Study Selection: Articles related to HR-MRI for MMD or other intracranial artery diseases were selected for review. Results: There are differences between the characteristic patterns of HR-MRI in MMD and ICAD. MMD is associated with inward remodeling, smaller outer diameters, concentric occlusive lesions and homogeneous signal intensity, while ICAD is more likely to be associated with outward remodeling, normal outer diameters, eccentric occlusive lesions, and heterogeneous signal intensity. Other intracranial artery diseases, such as dissection and vasculitis, also have distinctive characteristics in HR-MRI. HR-MRI may become a useful tool for the differential diagnosis of MMD in the future. Conclusions: HR-MRI of MMD provides a more in-depth understanding of MMD, and it is helpful in evaluating pathological changes in the vessel wall and in differentiating MMD from other intracranial artery steno-occlusive diseases, particularly ICAD.
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Affiliation(s)
| | | | | | | | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
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153
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Gon Y, Sakaguchi M, Oyama N, Mochizuki H. Diagnostic Utility of Contrast-enhanced 3D T1-weighted Imaging in Acute Cerebral Infarction Associated with Graves Disease. J Stroke Cerebrovasc Dis 2016; 26:e38-e40. [PMID: 27919794 DOI: 10.1016/j.jstrokecerebrovasdis.2016.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/04/2016] [Accepted: 11/06/2016] [Indexed: 11/18/2022] Open
Abstract
Graves disease is rarely complicated with cerebrovascular steno-occlusive diseases. Previous studies have suggested several hypotheses for this occurrence, including excess thyroid hormone, which stimulates the sympathetic nervous system, which in turn causes an abnormal hemodynamic response with consequent atherosclerotic changes, and antithyroid antibodies cause local vascular inflammation in patients with Graves disease. However, radiological findings of vasculitis in patients with Graves disease and cerebral infarction remain less known. We report the case of a 30-year-old Japanese woman with acute cerebral infarction due to vasculitis associated with Graves disease. She was admitted to our hospital with a 4-day history of intermittent transient dysarthria and limb shaking of the left leg when standing. Three weeks before admission, she went to a local hospital because of general malaise and was diagnosed with Graves disease. Neurological examination revealed paralytic dysarthria, left central facial nerve palsy, and left hemiparesis (manual muscle testing, 4 of 5). Blood examinations showed hyperthyroidism (thyroid-stimulating hormone ≤.010 µU/mL; free T3 ≥25.0 pg/mL; free T4 ≥8.0 ng/dL) and elevation of antithyroid antibody levels (thyroid peroxidase antibody, 87 IU/mL). The vessel wall of the right internal carotid artery was markedly enhanced on contrast-enhanced three-dimensional T1-weighted magnetic resonance imaging, suggesting vasculitis. Magnetic resonance angiography revealed right internal carotid artery occlusion after the branching ophthalmic artery. Arterial stenosis due to vasculitis was considered the cause of hemodynamic ischemic stroke. Vessel wall imaging such as high-resolution contrast-enhanced T1-weighted imaging seems useful for assessing the underlying mechanism of stroke in patients with Graves disease.
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Affiliation(s)
- Yasufumi Gon
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Manabu Sakaguchi
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoki Oyama
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan.
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154
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Lee NJ, Chung MS, Jung SC, Kim HS, Choi CG, Kim SJ, Lee DH, Suh DC, Kwon SU, Kang DW, Kim JS. Comparison of High-Resolution MR Imaging and Digital Subtraction Angiography for the Characterization and Diagnosis of Intracranial Artery Disease. AJNR Am J Neuroradiol 2016; 37:2245-2250. [PMID: 27659192 DOI: 10.3174/ajnr.a4950] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 07/22/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE High-resolution MR imaging has recently been introduced as a promising diagnostic modality in intracranial artery disease. Our aim was to compare high-resolution MR imaging with digital subtraction angiography for the characterization and diagnosis of various intracranial artery diseases. MATERIALS AND METHODS Thirty-seven patients who had undergone both high-resolution MR imaging and DSA for intracranial artery disease were enrolled in our study (August 2011 to April 2014). The time interval between the high-resolution MR imaging and DSA was within 1 month. The degree of stenosis and the minimal luminal diameter were independently measured by 2 observers in both DSA and high-resolution MR imaging, and the results were compared. Two observers independently diagnosed intracranial artery diseases on DSA and high-resolution MR imaging. The time interval between the diagnoses on DSA and high-resolution MR imaging was 2 weeks. Interobserver diagnostic agreement for each technique and intermodality diagnostic agreement for each observer were acquired. RESULTS High-resolution MR imaging showed moderate-to-excellent agreement (interclass correlation coefficient = 0.892-0.949; κ = 0.548-0.614) and significant correlations (R = 0.766-892) with DSA on the degree of stenosis and minimal luminal diameter. The interobserver diagnostic agreement was good for DSA (κ = 0.643) and excellent for high-resolution MR imaging (κ = 0.818). The intermodality diagnostic agreement was good (κ = 0.704) for observer 1 and moderate (κ = 0.579) for observer 2, respectively. CONCLUSIONS High-resolution MR imaging may be an imaging method comparable with DSA for the characterization and diagnosis of various intracranial artery diseases.
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Affiliation(s)
- N J Lee
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - M S Chung
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - S C Jung
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - H S Kim
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - C-G Choi
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - S J Kim
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - D H Lee
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - D C Suh
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - S U Kwon
- Department of Neurology (S.U.K., D.-W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - D-W Kang
- Department of Neurology (S.U.K., D.-W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - J S Kim
- Department of Neurology (S.U.K., D.-W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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155
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Vakil P, Elmokadem AH, Syed FH, Cantrell CG, Dehkordi FH, Carroll TJ, Ansari SA. Quantifying Intracranial Plaque Permeability with Dynamic Contrast-Enhanced MRI: A Pilot Study. AJNR Am J Neuroradiol 2016; 38:243-249. [PMID: 27856437 DOI: 10.3174/ajnr.a4998] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 08/22/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial atherosclerotic disease plaque hyperintensity and/or gadolinium contrast enhancement have been studied as imaging biomarkers of acutely symptomatic ischemic presentations using single static MR imaging measurements. However, the value in modeling the dynamics of intracranial plaque permeability has yet to be evaluated. The purpose of this study was to use dynamic contrast-enhanced MR imaging to quantify the contrast permeability of intracranial atherosclerotic disease plaques in symptomatic patients and to compare these parameters against existing markers of plaque volatility using black-blood MR imaging pulse sequences. MATERIALS AND METHODS We performed a prospective study of contrast uptake dynamics in the major intracranial vessels proximal and immediately distal to the circle of Willis using dynamic contrast-enhanced MR imaging, specifically in patients with symptomatic intracranial atherosclerotic disease. Using the Modified Tofts model, we extracted the volume transfer constant (Ktrans) and fractional plasma volume (Vp) parameters from plaque-enhancement curves. Using regression analyses, we compared these parameters against time from symptom onset as well as intraplaque hyperintensity and postcontrast enhancement derived from T1 SPACE, a black-blood MR vessel wall imaging sequence. RESULTS We completed analysis in 10 patients presenting with symptomatic intracranial atherosclerotic disease. Ktrans and Vp measurements were higher in plaques versus healthy white matter and similar or less than values in the choroid plexus. Only Ktrans correlated significantly with time from symptom onset (P = .02). Dynamic contrast-enhanced MR imaging parameters were not found to correlate significantly with intraplaque enhancement or intraplaque hyperintensity (P = .4 and P = .17, respectively). CONCLUSIONS Elevated Ktrans and Vp values found in intracranial atherosclerotic disease plaques versus healthy white matter suggest that dynamic contrast-enhanced MR imaging is a feasible technique for studying vessel wall and plaque characteristics in the proximal intracranial vasculature. Significant correlations between Ktrans and symptom onset, which were not observed on T1 SPACE-derived metrics, suggest that Ktrans may be an independent imaging biomarker of acute and symptom-associated pathologic changes in intracranial atherosclerotic disease plaques.
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Affiliation(s)
- P Vakil
- From the College of Medicine (P.V.), University of Illinois, Chicago, Illinois.,Departments of Radiology (P.V., A.H.E., F.S., C.G.C., T.J.C., S.A.A.).,Biomedical Engineering (P.V., C.G.C., T.J.C.)
| | - A H Elmokadem
- Departments of Radiology (P.V., A.H.E., F.S., C.G.C., T.J.C., S.A.A.)
| | - F H Syed
- Departments of Radiology (P.V., A.H.E., F.S., C.G.C., T.J.C., S.A.A.)
| | - C G Cantrell
- Departments of Radiology (P.V., A.H.E., F.S., C.G.C., T.J.C., S.A.A.).,Biomedical Engineering (P.V., C.G.C., T.J.C.)
| | - F H Dehkordi
- Department of Economics and Decision Sciences (F.H.D.), Western Illinois University, Macomb, Illinois
| | - T J Carroll
- Departments of Radiology (P.V., A.H.E., F.S., C.G.C., T.J.C., S.A.A.).,Biomedical Engineering (P.V., C.G.C., T.J.C.)
| | - S A Ansari
- Departments of Radiology (P.V., A.H.E., F.S., C.G.C., T.J.C., S.A.A.) .,Neurology and Neurological Surgery (S.A.A.), Northwestern University, Chicago, Illinois
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156
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Ansari SA, Kühn AL, Honarmand AR, Khan M, Hurley MC, Potts MB, Jahromi BS, Shaibani A, Gounis MJ, Wakhloo AK, Puri AS. Emergent Endovascular Management of Long-Segment and Flow-Limiting Carotid Artery Dissections in Acute Ischemic Stroke Intervention with Multiple Tandem Stents. AJNR Am J Neuroradiol 2016; 38:97-104. [PMID: 28059705 DOI: 10.3174/ajnr.a4965] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 08/18/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although most cervical dissections are managed medically, emergent endovascular treatment may become necessary in the presence of intracranial large-vessel occlusions, flow-limiting and long-segment dissections with impending occlusion, and/or hypoperfusion-related ischemia at risk of infarction. We investigated the role of emergent endovascular stenting of long-segment carotid dissections in the acute ischemic stroke setting. MATERIALS AND METHODS We retrospectively studied long-segment carotid dissections requiring stent reconstruction with multiple tandem stents (≥3 stents) and presenting with acute (<12 hours) ischemic stroke symptoms (NIHSS score, ≥4). We analyzed patient demographics, vascular risk factors, clinical presentations, imaging/angiographic findings, technical procedures/complications, and clinical outcomes. RESULTS Fifteen patients (mean age, 51.5 years) with acute ischemic stroke (mean NIHSS score, 15) underwent endovascular stent reconstruction for vessel and/or ischemic tissue salvage. All carotid dissections presented with >70% flow limiting stenosis and involved the distal cervical ICA with a minimum length of 3.5 cm. Carotid stent reconstruction was successful in all patients with no residual stenosis or flow limitation. Nine patients (60%) harbored intracranial occlusions, and 6 patients (40%) required intra-arterial thrombolysis/thrombectomy, achieving 100% TICI 2b-3 reperfusion. Two procedural complications were limited to thromboembolic infarcts from in-stent thrombus and asymptomatic hemorrhagic infarct transformation (7% morbidity, 0% mortality). Angiographic and ultrasound follow-up confirmed normal carotid caliber and stent patency, with 2 cases of <20% in-stent stenosis. Early clinical improvement resulted in a mean discharge NIHSS score of 6, and 9/15 (60%) patients achieved a 90-day mRS of ≤2. CONCLUSIONS Emergent stent reconstruction of long-segment and flow-limiting carotid dissections in acute ischemic stroke intervention is safe and effective, with favorable clinical outcomes, allowing successful thrombectomy, vessel salvage, restoration of cerebral perfusion, and/or prevention of recurrent thromboembolic stroke.
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Affiliation(s)
- S A Ansari
- From the Departments of Radiology, Neurology, and Neurological Surgery (S.A.A., A.R.H., M.C.H., M.B.P., B.S.J., A.S.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - A L Kühn
- Division of Neuroimaging and Intervention (A.L.K., M.J.G., A.K.W., A.S.P.), Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts
| | - A R Honarmand
- From the Departments of Radiology, Neurology, and Neurological Surgery (S.A.A., A.R.H., M.C.H., M.B.P., B.S.J., A.S.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - M Khan
- Department of Neurology (M.K.), Brown University, Providence, Rhode Island
| | - M C Hurley
- From the Departments of Radiology, Neurology, and Neurological Surgery (S.A.A., A.R.H., M.C.H., M.B.P., B.S.J., A.S.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - M B Potts
- From the Departments of Radiology, Neurology, and Neurological Surgery (S.A.A., A.R.H., M.C.H., M.B.P., B.S.J., A.S.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - B S Jahromi
- From the Departments of Radiology, Neurology, and Neurological Surgery (S.A.A., A.R.H., M.C.H., M.B.P., B.S.J., A.S.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - A Shaibani
- From the Departments of Radiology, Neurology, and Neurological Surgery (S.A.A., A.R.H., M.C.H., M.B.P., B.S.J., A.S.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - M J Gounis
- Division of Neuroimaging and Intervention (A.L.K., M.J.G., A.K.W., A.S.P.), Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts
| | - A K Wakhloo
- Division of Neuroimaging and Intervention (A.L.K., M.J.G., A.K.W., A.S.P.), Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts
| | - A S Puri
- Division of Neuroimaging and Intervention (A.L.K., M.J.G., A.K.W., A.S.P.), Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts
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157
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Du J, Yang F, Liu X. Letter by Du et al Regarding Article, "Magnetic Resonance Imaging of Plaque Morphology, Burden, and Distribution in Patients With Symptomatic Middle Cerebral Artery Stenosis". Stroke 2016; 47:e254. [PMID: 27650068 DOI: 10.1161/strokeaha.116.014795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Juan Du
- Department of Neurology Jinling Hospital Second Military Medical University Nanjing, China
| | - Fang Yang
- Department of Neurology Jinling Hospital Second Military Medical University Nanjing, China
| | - Xinfeng Liu
- Department of Neurology Jinling Hospital Second Military Medical University Nanjing, China
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158
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Takano K, Hida K, Kuwabara Y, Yoshimitsu K. Intracranial arterial wall enhancement using gadolinium-enhanced 3D black-blood T1-weighted imaging. Eur J Radiol 2016; 86:13-19. [PMID: 28027739 DOI: 10.1016/j.ejrad.2016.10.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 08/04/2016] [Accepted: 10/29/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE We investigated the enhancement of the intracranial arterial walls with gadolinium-enhanced, black-blood three-dimensional T1-weighted imaging (Gd-3DBB) by using an improved motion-sensitized driven-equilibrium (iMSDE)-prepared volumetric isotropic turbo spin-echo acquisition (VISTA). METHODS A total of 115 patients underwent FLAIR, 3D-TOF-MRA and Gd-3DBB with a 1.5-T scanner. The degree and distribution of the arterial wall enhancement on Gd-3DBB was assessed. The association of the degree of wall enhancement with brain infarction/ischemic lesions on FLAIR, luminal changes on 3D-TOF-MRA, and cardiovascular risk factors (CVRFs) was investigated by univariate and multiple logistic regression analyses. RESULTS Strong enhancement of the arterial walls was observed in 77 vertebral arteries (33.5%), 4 basilar arteries (3.5%), 31 supraclinoid internal carotid arteries (ICAs) (13.5%) and 8 middle cerebral arteries (3.5%). In addition, 221 intrapetrous ICAs (96.1%) showed strong enhancement. After adjusting for confounding factors, multivariate analyses showed that the patient age was independently associated with the strong wall enhancement of the arteries for both the posterior (OR, 1.088; 95% CI, 1.034-1.146) and the anterior circulation (OR, 1.098, 95% CI 1.029-1.172). In addition, the presence of the supratentorial brain infarctions was independently associated with the strong wall enhancement in the anterior circulation excluding the intrapetrous ICAs (OR, 4.097; 95% CI, 1.483-11.319). CONCLUSIONS Although the arterial wall enhancement on the Gd-3DBB probably reflects normal aging, the enhancement in the anterior circulation might be related to brain infarctions. On the other hand, the intrapetrous ICA enhancement is considered a nonspecific finding and should not be mistaken for arterial pathologies such as atherosclerosis or arteritis.
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Affiliation(s)
- Koichi Takano
- Department of Radiology, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
| | - Kosuke Hida
- Department of Radiology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yasuo Kuwabara
- Department of Radiology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Kengo Yoshimitsu
- Department of Radiology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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159
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Jang HW, Lee HJ, Lee J, Won C, Youn SW, Han M, Chang Y. Voxel-based Histographic Analysis of the Basilar Artery in Patients with Isolated Pontine Infarction. Magn Reson Med Sci 2016; 15:355-364. [PMID: 26902678 PMCID: PMC5608109 DOI: 10.2463/mrms.mp.2015-0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose: The signal information per voxels of magnetic resonance imaging (MRI) for vessel wall could reflect the pathologic features of atherosclerotic vessels. The aim of this study is to evaluate the usefulness of magnetic resonance voxel-based histogram (VBH) of atherosclerotic basilar artery in patients with isolated pontine infarctions (PIs). Materials and Methods: Wall and lumen of basilar artery were segmented from high resolution MR of 42 patients with isolated PI and 10 normal volunteers. VBHs were obtained after normalization by dividing the intensity of segmented wall with the intensity of non-infarcted area of pons. The variables of VBH included area (A), mean signal intensity (SI), standard deviation (SD), kurtosis (K), and skewness (SK) and area stenosis [AS; Awall/(Awall + Alumen)] were compared according to the MRI-modified American Heart Association (AHA) atherosclerotic plaque schema, and between the subgroups of PI (lacunar: LPI and paramedian: PPI). Results: According to the MRI-modified AHA atherosclerotic plaque schema, Awall/T1 (mean area of wall on T1-weighted MRI), SIwall/T1, SDwall/T1, SKwall/T1, Kwall/T1, Alumen/T1, and AST1 showed statistical differences. AHA IV–VII showed higher Awall/T1, SIwall/T1, and AST1 than normal control. PPI showed statistical differences in Awall/T1, SIwall/T1, SK wall/T1, and Awall/T2 than those of normal control after post hoc test, whereas LPI in Awall/T1 and Awall/T2 (P < 0.05, Kruskal-Wallis test, Dunnett T3 procedure). Conclusions: VBH analysis can provide the quantitative information with regard to volume as well as composition of the atherosclerotic plaque in the basilar artery. The difference in patterns of VBH might be further useful in characterizing PIs with presumably different pathogenesis.
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160
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Qiao Y, Guallar E, Suri FK, Liu L, Zhang Y, Anwar Z, Mirbagheri S, Xie YJ, Nezami N, Intrapiromkul J, Zhang S, Alonso A, Chu H, Couper D, Wasserman BA. MR Imaging Measures of Intracranial Atherosclerosis in a Population-based Study. Radiology 2016; 280:860-8. [PMID: 27022858 PMCID: PMC5006718 DOI: 10.1148/radiol.2016151124] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose To implement a magnetic resonance (MR) imaging protocol to measure intracranial atherosclerotic disease (ICAD) in a population-based multicenter study and report examination and reader reliability of these MR imaging measurements and descriptive statistics representative of the general population. Materials and Methods This prospective study was approved by the institutional review boards and compliant with HIPAA. Atherosclerosis Risk in Communities (ARIC) study participants (n = 1980) underwent brain MR imaging from 2011 to 2013 at four ARIC sites. Imaging included three-dimensional black-blood MR imaging and time-of-flight MR angiography. One hundred two participants returned for repeat MR imaging to estimate examination and reader variability. Plaque presence according to vessel segment was recorded. Quantitative measurements included lumen size and degree of stenosis, wall and/or plaque thickness, area and volume, and normalized wall index for each vessel segment. Reliability was assessed with percentage agreement, κ statistics, and intraclass correlation coefficients. Results Of the 1980 participants, 1755 (mean age, 77.6 years; 1026 women [59%]; 1234 white [70%]) completed examinations with adequate to excellent image quality. The weighted ICAD prevalence was 34.4% (637 of 1755 participants) and was higher in men than women (38.5% [302 of 729 participants] vs 31.7% [335 of 1026 participants], respectively; P = .012) and in African Americans compared with whites (41.1% [215 of 518 participants] vs 32.4% [422 of 1234 participants], respectively; P = .002). Percentage agreement of plaque identification per participant was 87.0% (interreader estimate), 89.2% (intrareader estimate), and 89.9% (examination estimate). Examination and reader reliability ranged from fair to good (κ, 0.50-0.78) for plaque presence and from good to excellent (intraclass correlation coefficient, 0.69-0.99) for quantitative vessel wall measurements. Conclusion Vessel wall MR imaging is a reliable tool for identifying and measuring ICAD and provided insight into ICAD distribution across a U.S. community-based population. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Ye Qiao
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Eliseo Guallar
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Fareed K. Suri
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Li Liu
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Yiyi Zhang
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Zeeshan Anwar
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Saeedeh Mirbagheri
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - YuanYuan Joyce Xie
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Nariman Nezami
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Jarunee Intrapiromkul
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Shuqian Zhang
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Alvaro Alonso
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Haitao Chu
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - David Couper
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
| | - Bruce A. Wasserman
- From The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD 21287 (Y.Q., L.L., Z.A., S.M., Y.J.X., N.N., J.I., S.Z., B.A.W.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (E.G., Y.Z.); Department of Neurology, University of Minnesota, Minneapolis, Minn (F.K.S.); School of Public Health, University of Minnesota, Minneapolis, Minn (A.A., H.C.); School of Public Health, University of North Carolina, Chapel Hill, NC (D.C.)
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161
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Kim YJ, Lee JK, Ahn SH, Kim BJ, Kang DW, Kim JS, Kwon SU. Nonatheroscleotic Isolated Middle Cerebral Artery Disease May Be Early Manifestation of Moyamoya Disease. Stroke 2016; 47:2229-35. [DOI: 10.1161/strokeaha.116.012751] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 07/01/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Middle cerebral artery steno-occlusive disease (MCAD) is not an uncommon cause of ischemic stroke in young Asians. Aside from atherosclerosis, the pathogenesis of MCAD include various nonatherosclerotic vasculopathies, most of which are yet to be defined. This study investigated the pathogenesis of symptomatic isolated MCAD in young Asian patients using high-resolution magnetic resonance imaging (HR-MRI) and mutation analysis of
RNF213
.
Methods—
Patients aged <60 years with stroke or transient ischemic attack caused by MCAD were prospectively enrolled. Patients with a confirmed diagnosis of moyamoya disease, dissection, and vasculitis; with significant steno-occlusion in cerebral arteries other than the MCA; or with high-risk cardioembolic source were excluded. Using high-resolution MRI, patients were classified into an atherosclerosis group and a nonatherosclerosis group.
Results—
Eighty-one patients were enrolled, 45 (56.6%) in the atherosclerosis and 36 (44.4%) in the nonatherosclerosis group. The nonatherosclerosis group was significantly younger (
P
=0.013), had a smaller number of vascular risk factors (
P
=0.001), showed a lower homocysteine level (
P
<0.001), thinner intima-media thickness (
P
=0.006), and had more frequent heterozygotes at
RNF213
(
P
=0.045) than the atherosclerosis group. Diffusion-weighted image lesion pattern showed no significant differences in assumed stroke mechanisms between the 2 groups.
Conclusions—
Nonatherosclerotic pathogenesis are common in young Asians with symptomatic isolated MCAD. Clinical findings, high-resolution MRI features, and results of
RNF213
mutation analysis suggest that moyamoya disease is responsible etiologically for a significant portion of nonatherosclerotic lesions. Symptomatic isolated MCAD may be an early manifestation of moyamoya disease in young Asian adults.
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Affiliation(s)
- Yeon-Jung Kim
- From the Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Y.-J. K., J.-K. L., S.-H. A., D.-W. J., J.S.K., S.U.K.); and Department of Neurology, Kyung Hee University Hospital, Seoul, Korea (B.J.K.)
| | - Joo Kyung Lee
- From the Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Y.-J. K., J.-K. L., S.-H. A., D.-W. J., J.S.K., S.U.K.); and Department of Neurology, Kyung Hee University Hospital, Seoul, Korea (B.J.K.)
| | - Sung-Ho Ahn
- From the Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Y.-J. K., J.-K. L., S.-H. A., D.-W. J., J.S.K., S.U.K.); and Department of Neurology, Kyung Hee University Hospital, Seoul, Korea (B.J.K.)
| | - Bum Joon Kim
- From the Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Y.-J. K., J.-K. L., S.-H. A., D.-W. J., J.S.K., S.U.K.); and Department of Neurology, Kyung Hee University Hospital, Seoul, Korea (B.J.K.)
| | - Dong-Wha Kang
- From the Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Y.-J. K., J.-K. L., S.-H. A., D.-W. J., J.S.K., S.U.K.); and Department of Neurology, Kyung Hee University Hospital, Seoul, Korea (B.J.K.)
| | - Jong S. Kim
- From the Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Y.-J. K., J.-K. L., S.-H. A., D.-W. J., J.S.K., S.U.K.); and Department of Neurology, Kyung Hee University Hospital, Seoul, Korea (B.J.K.)
| | - Sun U. Kwon
- From the Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Y.-J. K., J.-K. L., S.-H. A., D.-W. J., J.S.K., S.U.K.); and Department of Neurology, Kyung Hee University Hospital, Seoul, Korea (B.J.K.)
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162
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Yang H, Zhang X, Qin Q, Liu L, Wasserman BA, Qiao Y. Improved cerebrospinal fluid suppression for intracranial vessel wall MRI. J Magn Reson Imaging 2016; 44:665-72. [PMID: 26950926 DOI: 10.1002/jmri.25211] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/10/2016] [Indexed: 08/29/2024] Open
Abstract
PURPOSE To develop and assess a three-dimensional (3D) high resolution black blood MRI (BBMRI) method for evaluation of intracranial vessels with improved cerebrospinal fluid (CSF) suppression. MATERIALS AND METHODS The anti-driven-equilibrium (ADE) pulse was incorporated into a variable flip-angle TSE-based 3D BBMRI to improve CSF suppression. ADE-BBMRI was optimized in 8 participants and compared with BBMRI, with acquired 0.5 mm isotropic resolution and scan time of 5.4 min at 3 Tesla. Contrast-enhanced ADE-BBMRI protocol was implemented in nine patients with intracranial atherosclerosis. Signal and morphological measurements were compared between ADE-BBMRI and BBMRI, as well as pre- and postcontrast ADE-BBMRI. Reliability was assessed by intraclass correlations (ICC). RESULTS ADE-BBMRI effectively suppressed the surrounding CSF signal of intracranial vessels, with a 36-44% reduction compared with BBMRI. ADE-BBMRI also reduced the overall wall signal by 8-8.5%, but provided a significant improvement in wall-to-CSF contrast-to-noise ratio over BBMRI (middle cerebral artery, 5.93 ± 0.59 versus 3.95 ± 1.67, P < 0.01; basilar artery, 3.8 ± 1.76 versus 1.34 ± 0.54, P = 0.01, respectively). No differences were noted in morphological measurements between ADE-BBMRI and BBMRI (lumen area, 6.35 ± 2.87 versus 6.32 ± 2.84 mm(2) ; wall area, 1.28 ± 0.52 versus 1.27 ± 0.53 mm(2) ; mean wall thickness, 0.93 ± 0.30 versus 0.93 ± 0.32 mm; maximum wall thickness, 1.27 ± 0.33 versus 1.28 ± 0.36 mm, all P > 0.05). Contrast enhanced ADE-BBMRI improved the plaque delineation by the increased wall signal, wall-to-CSF and wall-to-blood contrast-to-noise ratio. ICC ranged from 0.54 to 0.95. CONCLUSION The 3D ADE-BBMRI provides excellent blood and CSF suppression, and accurate measurements of intracranial vessels at 0.5 mm isotropic resolution in 5 min. Its clinical application may provide insight into stroke risk. J. Magn. Reson. Imaging 2016;44:665-672.
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Affiliation(s)
- Huan Yang
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, China
| | - Xuefeng Zhang
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, Maryland, USA
- Department of Radiology, Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia, China
| | - Qin Qin
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, Maryland, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Li Liu
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Bruce A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ye Qiao
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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163
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Yu LB, He H, Zhao JZ, Wang R, Zhang Q, Shi ZY, Shao JS, Zhang D. More Precise Imaging Analysis and Diagnosis of Moyamoya Disease and Moyamoya Syndrome Using High-Resolution Magnetic Resonance Imaging. World Neurosurg 2016; 96:252-260. [PMID: 27576769 DOI: 10.1016/j.wneu.2016.08.083] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/17/2016] [Accepted: 08/18/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND The diagnosis of moyamoya disease (MMD) is often uncertain. Moyamoya syndrome (MMS) is often misdiagnosed as MMD. High-resolution magnetic resonance imaging (HR-MRI) enables vessel wall assessment to obtain more precise diagnoses. The aim of this study was to determine the true etiologies of arterial steno-occlusion in patients with an angiographic diagnosis of MMD or MMS using HR-MRI. METHODS HR-MRI was performed in 21 adult patients with angiographically proven MMD or MMS. A definite diagnosis was based on the HR-MRI findings. The diagnoses made via the 2 different imaging technologies were compared, and significant findings were analyzed. RESULTS A total of 21 patients were enrolled, including 7 patients with angiographically proven MMD and 14 patients with angiographically proven MMS. Among the 7 patients with MMD, HR-MRI confirmed the diagnosis of MMD in 6; the remaining patient was considered to have atherosclerosis in the bilateral distal internal carotid arteries (ICAs) and the left middle cerebral artery. Among the 14 patients with MMS, HR-MRI confirmed MMD in 6 patients (including 2 patients with unilateral MMD), atherosclerosis in 5 patients (including 3 patients with bilateral atherosclerosis and 2 with unilateral atherosclerosis), arterial dissection of the left ICA in 1 patient, and MMD in the left cerebral hemisphere with atherosclerosis in the right hemisphere in 2 patients. CONCLUSIONS Differentiating MMD from MMS is difficult in certain situations, and HR-MRI may help provide a more in-depth understanding of MMD and MMS, thereby achieving a more reliable diagnosis.
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Affiliation(s)
- Le-Bao Yu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Huan He
- Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ji-Zong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Qian Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhi-Yong Shi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jun-Shi Shao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China.
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164
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Wilson N, Pohl D, Michaud J, Doja A, Miller E. MRI and clinicopathological correlation of childhood primary central nervous system angiitis. Clin Radiol 2016; 71:1160-7. [PMID: 27554617 DOI: 10.1016/j.crad.2016.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/30/2016] [Accepted: 07/18/2016] [Indexed: 11/28/2022]
Abstract
AIM To review the long-term clinical and imaging follow-up of eight children with histopathologically proven childhood primary central nervous system angiitis (cPACNS). MATERIALS AND METHODS Eight children (5-17 years, five female and three male patients) with biopsy-proven cPACNS vasculitis were reviewed retrospectively. All children were followed at the Children's Hospital of Eastern Ontario. Magnetic resonance imaging (MRI) images of the brain parenchyma and vessel pattern of the arteries of the circle of Willis were reviewed at baseline and follow-up(s). All MRI images were correlated with clinical and histopathological findings. RESULTS Seven (87.5%) children demonstrated parenchymal abnormalities: five of the seven (71.4%) presented with non-haemorrhagic lesions, one (14.3%) presented with a parenchymal bleed, and one (14.3%) showed diffuse oedema. One child remained negative for brain parenchymal abnormality at baseline and follow-up. Of the seven children with a parenchymal abnormality, parenchymal enhancement was seen in two (28.5%) and leptomeningeal enhancement was seen in one child. Only two children had positive diffusion-weighted imaging (DWI) restriction at baseline. Five of the seven children (71.4%) showed no magnetic resonance angiography (MRA) abnormalities at baseline. In one, MRA detected complete absence of flow. Follow-up MRA (24-74 months) demonstrated that five of the seven (71.4%) children had progressive paucity of the peripheral vascularity. Two children (28.5%) with shorter-term follow-up (7 and 13 months) did not demonstrate MRA changes. CONCLUSION Long-term follow-up MRA demonstrated progressive paucity of peripheral vessels, which could be secondary to the inflammation affecting the peripheral vasculature causing reduction in vessel lumen size beyond the resolution of the maximum intensity projection (MIP) reconstruction.
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Affiliation(s)
- N Wilson
- Diagnostic Imaging Department, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON K1H 8L1 Canada.
| | - D Pohl
- Diagnostic Imaging Department, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON K1H 8L1 Canada
| | - J Michaud
- Diagnostic Imaging Department, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON K1H 8L1 Canada
| | - A Doja
- Diagnostic Imaging Department, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON K1H 8L1 Canada
| | - E Miller
- Diagnostic Imaging Department, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON K1H 8L1 Canada
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165
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Dieleman N, Yang W, van der Kolk AG, Abrigo J, Lee KL, Chu WCW, Zwanenburg JJM, Siero JCW, Wong KS, Hendrikse J, Chen FXY. Qualitative Evaluation of a High-Resolution 3D Multi-Sequence Intracranial Vessel Wall Protocol at 3 Tesla MRI. PLoS One 2016; 11:e0160781. [PMID: 27532106 PMCID: PMC4988776 DOI: 10.1371/journal.pone.0160781] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 07/25/2016] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Intracranial vessel wall imaging using MRI has great potential as a clinical method for assessing intracranial atherosclerosis. The purpose of the current study was to compare three 3T MRI vessel wall sequences with different contrast weightings (T1w, PD, T2w) and dedicated sagittal orientation perpendicular to the middle cerebral artery, to the reconstructed sagittal image from a transverse 3D T1w volumetric isotropically reconstructed turbo spin-echo acquisition (VIRTA), and provide a clinical recommendation. Materials and Methods The above-mentioned sequences were acquired in 10 consecutive Chinese ischemic stroke or TIA patients (age: 68 years, sex: 4 females) with angiographic-confirmed MCA stenosis at 3T. Institutional review board approval was obtained. Two raters qualitatively scored all images on overall image quality, presence of artifacts, and visibility of plaques. Data were compared using Repeated measures ANOVA and Sidak’s adjusted post hoc tests. Results All sequences except the T2w sequence were able to depict the walls of the large vessels of the Circle of Willis (p<0.05). T1w sagittal oblique VIRTA showed significantly more artifacts (p<0.01). Peripherally located plaques were sometimes missed on the sagittal sequences, but could be appreciated on the transverse T1w VIRTA. Conclusion With the 3T multi-sequence vessel wall protocol we were able to assess the intracranial plaque with two different image contrast weightings. The sequence of preference to include in a clinical protocol would be the transverse 3D T1w VIRTA based on absence of artifacts, larger coverage including the whole Circle of Willis, and excellent lesion depiction.
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Affiliation(s)
- Nikki Dieleman
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wenjie Yang
- Department of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Anja G. van der Kolk
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jill Abrigo
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ka Lok Lee
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jaco J. M. Zwanenburg
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen C. W. Siero
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Spinoza Centre for Neuroimaging, Amsterdam, The Netherlands
| | - Ka Sing Wong
- Department of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Fiona Xiang Yan Chen
- Department of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- * E-mail: ;
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166
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Treitl KM, Maurus S, Sommer NN, Kooijman-Kurfuerst H, Coppenrath E, Treitl M, Czihal M, Hoffmann U, Dechant C, Schulze-Koops H, Saam T. 3D-black-blood 3T-MRI for the diagnosis of thoracic large vessel vasculitis: A feasibility study. Eur Radiol 2016; 27:2119-2128. [PMID: 27510630 DOI: 10.1007/s00330-016-4525-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 07/19/2016] [Accepted: 07/21/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the feasibility of T1w-3D black-blood turbo spin echo (TSE) sequence with variable flip angles for the diagnosis of thoracic large vessel vasculitis (LVV). METHODS Thirty-five patients with LVV, diagnosed according to the current standard of reference, and 35 controls were imaged at 3.0T using 1.2 × 1.3 × 2.0 mm3 fat-suppressed, T1w-3D, modified Volumetric Isotropic TSE Acquisition (mVISTA) pre- and post-contrast. Applying a navigator and peripheral pulse unit triggering (PPU), the total scan time was 10-12 min. Thoracic aorta and subclavian and pulmonary arteries were evaluated for image quality (IQ), flow artefact intensity, diagnostic confidence, concentric wall thickening and contrast enhancement (CWT, CCE) using a 4-point scale. RESULTS IQ was good in all examinations (3.25 ± 0.72) and good to excellent in 342 of 408 evaluated segments (83.8 %), while 84.1 % showed no or minor flow artefacts. The interobserver reproducibility for the identification of CCE and CWT was 0.969 and 0.971 (p < 0.001) with an average diagnostic confidence of 3.47 ± 0.64. CCE and CWT were strongly correlated (Cohen's k = 0.87; P < 0.001) and significantly more frequent in the LVV-group (52.8 % vs. 1.0 %; 59.8 % vs. 2.4 %; P < 0.001). CONCLUSIONS Navigated fat-suppressed T1w-3D black-blood MRI with PPU-triggering allows diagnosis of thoracic LVV. KEY POINTS • Cross-sectional imaging is frequently applied in the diagnosis of LVV. • Navigated, PPU-triggered, T1w-3D mVISTA pre- and post contrast takes 10-12 min. • In this prospective, single-centre study, T1w-3D mVISTA accurately depicted large thoracic vessels. • T1w-3D mVISTA visualized CWT/CCW as correlates of mural inflammation in LVV. • T1w-3D mVISTA might be an alternative diagnostic tool without ionizing radiation.
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Affiliation(s)
- Karla Maria Treitl
- Institute for Clinical Radiology, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany. .,German Center for Cardiovascular Disease Research (DZHK e. V.), Pettenkoferstr. 8a, 80336, Munich, Germany.
| | - Stefan Maurus
- Institute for Clinical Radiology, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - Nora Narvina Sommer
- Institute for Clinical Radiology, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | | | - Eva Coppenrath
- Institute for Clinical Radiology, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - Marcus Treitl
- Institute for Clinical Radiology, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - Michael Czihal
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, LMU Munich, Pettenkoferstr. 8a, D-80336, Munich, Germany
| | - Ulrich Hoffmann
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, LMU Munich, Pettenkoferstr. 8a, D-80336, Munich, Germany
| | - Claudia Dechant
- Division of Rheumatology and Clinical Immunology, Medical Clinic and Policlinic IV, LMU Munich, Pettenkoferstr. 8a, D-80336, Munich, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Medical Clinic and Policlinic IV, LMU Munich, Pettenkoferstr. 8a, D-80336, Munich, Germany
| | - Tobias Saam
- Institute for Clinical Radiology, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany.,German Center for Cardiovascular Disease Research (DZHK e. V.), Pettenkoferstr. 8a, 80336, Munich, Germany
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167
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Han C, Li ML, Xu YY, Ye T, Xie CF, Gao S, Duan L, Xu WH. Adult moyamoya-atherosclerosis syndrome: Clinical and vessel wall imaging features. J Neurol Sci 2016; 369:181-184. [PMID: 27653886 DOI: 10.1016/j.jns.2016.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/20/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION We sought to incorporate high-resolution magnetic resonance imaging (HRMRI) into the diagnostic process of intracranial atherosclerosis associated moyamoya syndrome in adult patients. METHODS From March 2013 to March 2014, HRMRI was consecutively performed on adult patients with angiographic moyamoya. The patients were classified as moyamoya - plaques (MMD-P) if a plaque could be identified or as moyamoya - no plaques (MMD-NP) if a plaque could not be identified. The angiography, HRMRI findings and atherogenic risk factors of these patients were analyzed. RESULTS Fifty-one patients (mean age 39±9, 20 males) were enrolled. On traditional angiography, probable intracranial atherosclerosis was identified in 5 patients, no definite diagnosis in 12 patients, and moyamoya disease in 34 patients. On HRMRI, 15 out of 32 patients with risk factors and 4 out of 19 patients without risk factors were found to have plaques and were diagnosed as MMD-P, while the other 32 patients were diagnosed as MMD-NP. The MMD-P patients were more likely to be older (P=0.033) and male (P=0.0353) and were less likely to have cerebral hemorrhage (P=0.0066) and a history of disease progression (P=0.0012). CONCLUSIONS Our study suggests that HRMRI can help diagnose intracranial atherosclerosis more accurately in moyamoya disease patients with atherogenic risk factors. The distinct clinical features between MMD-P and MMD-NP patients suggest different underlying pathophysiology and therefore potentially different treatment strategies.
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Affiliation(s)
- Cong Han
- Department of Neurosurgery, 307 Hospital, PLA, Beijing, China
| | - Ming-Li Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yu-Yuan Xu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ting Ye
- Department of Neurosurgery, 307 Hospital, PLA, Beijing, China
| | - Chen-Fan Xie
- Department of Neurosurgery, 307 Hospital, PLA, Beijing, China
| | - Shan Gao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lian Duan
- Department of Neurosurgery, 307 Hospital, PLA, Beijing, China.
| | - Wei-Hai Xu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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168
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Mandell DM, Mossa-Basha M, Qiao Y, Hess CP, Hui F, Matouk C, Johnson MH, Daemen MJAP, Vossough A, Edjlali M, Saloner D, Ansari SA, Wasserman BA, Mikulis DJ. Intracranial Vessel Wall MRI: Principles and Expert Consensus Recommendations of the American Society of Neuroradiology. AJNR Am J Neuroradiol 2016; 38:218-229. [PMID: 27469212 DOI: 10.3174/ajnr.a4893] [Citation(s) in RCA: 418] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Intracranial vessel wall MR imaging is an adjunct to conventional angiographic imaging with CTA, MRA, or DSA. The technique has multiple potential uses in the context of ischemic stroke and intracranial hemorrhage. There remain gaps in our understanding of intracranial vessel wall MR imaging findings and research is ongoing, but the technique is already used on a clinical basis at many centers. This article, on behalf of the Vessel Wall Imaging Study Group of the American Society of Neuroradiology, provides expert consensus recommendations for current clinical practice.
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Affiliation(s)
- D M Mandell
- From the Division of Neuroradiology (D.M.M., D.J.M.), Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - M Mossa-Basha
- Department of Radiology (M.M.-B.), University of Washington, Seattle, Washington
| | - Y Qiao
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., F.H., B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
| | - C P Hess
- Department of Radiology and Biomedical Imaging (C.P.H., D.S.), University of California, San Francisco, San Francisco, California
| | - F Hui
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., F.H., B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
| | - C Matouk
- Departments of Neurosurgery (C.M., M.H.J.).,Radiology and Biomedical Imaging (C.M., M.H.J.)
| | - M H Johnson
- Departments of Neurosurgery (C.M., M.H.J.).,Radiology and Biomedical Imaging (C.M., M.H.J.).,Surgery (M.H.J.), Yale University School of Medicine, New Haven, Connecticut
| | - M J A P Daemen
- Department of Pathology (M.J.A.P.D.), Academic Medical Center, Amsterdam, the Netherlands
| | - A Vossough
- Departments of Surgery (A.V.).,Radiology (A.V.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - M Edjlali
- Department of Radiology (M.E.), Université Paris Descartes Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale S894, Centre Hospitalier Sainte-Anne, Paris, France
| | - D Saloner
- Department of Radiology and Biomedical Imaging (C.P.H., D.S.), University of California, San Francisco, San Francisco, California
| | - S A Ansari
- Departments of Radiology (S.A.A.).,Neurology (S.A.A.).,Neurological Surgery (S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - B A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., F.H., B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
| | - D J Mikulis
- From the Division of Neuroradiology (D.M.M., D.J.M.), Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Ontario, Canada
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169
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Abstract
The child presenting with possible sentinel transient ischemic event or stroke requires prompt diagnosis so that strategies to limit injury and prevent recurrent stroke can be instituted. Cerebral arteriopathy is a potent risk factor for arterial ischemic stroke in childhood. Though acute imaging study in the setting of possible stroke is often a head computed tomography, when possible magnetic resonance imaging (MRI) is recommended as the first-line study as confirmation and imaging evaluation of ischemic stroke will typically require MRI. The MRI scanning approach should include diffusion-weighted imaging (DWI) early in the sequence order, since normal DWI excludes acute infarct with rare exception. In most cases, arterial imaging with time-of-flight (TOF) magnetic resonance angiography (MRA) is warranted. Dedicated MRA may not be possible in the acute setting, but should be pursued as promptly as possible, particularly in the child with findings and history suggestive of arteriopathy, given the high risk of recurrent stroke in these children. MRA can overestimate the degree of arterial compromise due to complex/turbulent flow, and be insensitive to subtle vessel irregularity due to resolution and complex flow. In cases with high imaging suspicion for dissection despite normal MRA findings, catheter angiogram is indicated. A thoughtful, stepwise approach to arterial neuroimaging is critical to optimize diagnosis, treatment, and primary and secondary prevention of childhood stroke.
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Affiliation(s)
| | - Dennis Shaw
- Department of Radiology, Seattle Children's Hospital, Seattle, WA, USA
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170
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Harteveld AA, van der Kolk AG, van der Worp HB, Dieleman N, Siero JCW, Kuijf HJ, Frijns CJM, Luijten PR, Zwanenburg JJM, Hendrikse J. High-resolution intracranial vessel wall MRI in an elderly asymptomatic population: comparison of 3T and 7T. Eur Radiol 2016; 27:1585-1595. [PMID: 27387876 PMCID: PMC5334422 DOI: 10.1007/s00330-016-4483-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/07/2016] [Accepted: 06/21/2016] [Indexed: 01/20/2023]
Abstract
Objectives Several intracranial vessel wall sequences have been described in recent literature, with either 3-T or 7-T magnetic resonance imaging (MRI). In the current study, we compared 3-T and 7-T MRI in visualising both the intracranial arterial vessel wall and vessel wall lesions. Methods Twenty-one elderly asymptomatic volunteers were scanned by 3-T and 7-T MRI with an intracranial vessel wall sequence, both before and after contrast administration. Two raters scored image quality, and presence and characteristics of vessel wall lesions. Results Vessel wall visibility was equal or significantly better at 7 T for the studied arterial segments, even though there were more artefacts hampering assessment. The better visualisation of the vessel wall at 7 T was most prominent in the proximal anterior cerebral circulation and the posterior cerebral artery. In the studied elderly asymptomatic population, 48 vessel-wall lesions were identified at 3 T, of which 7 showed enhancement. At 7 T, 79 lesions were identified, of which 29 showed enhancement. Seventy-one percent of all 3-T lesions and 59 % of all 7-T lesions were also seen at the other field strength. Conclusions Despite the large variability in detected lesions at both field strengths, we believe 7-T MRI has the highest potential to identify the total burden of intracranial vessel wall lesions. Key Points • Intracranial vessel wall visibility was equal or significantly better at 7-T MRI • Most vessel wall lesions in the cerebral arteries were found at 7-T MRI • Many intracranial vessel wall lesions showed enhancement after contrast administration • Large variability in detected intracranial vessel wall lesions at both field strengths • Seven-tesla MRI has the highest potential to identify total burden of intracranial atherosclerosis Electronic supplementary material The online version of this article (doi:10.1007/s00330-016-4483-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anita A Harteveld
- Department of Radiology, University Medical Center Utrecht, Postbox 85500, 3508 GA, Utrecht, The Netherlands.
| | - Anja G van der Kolk
- Department of Radiology, University Medical Center Utrecht, Postbox 85500, 3508 GA, Utrecht, The Netherlands
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nikki Dieleman
- Department of Radiology, University Medical Center Utrecht, Postbox 85500, 3508 GA, Utrecht, The Netherlands
| | - Jeroen C W Siero
- Department of Radiology, University Medical Center Utrecht, Postbox 85500, 3508 GA, Utrecht, The Netherlands
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Catharina J M Frijns
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter R Luijten
- Department of Radiology, University Medical Center Utrecht, Postbox 85500, 3508 GA, Utrecht, The Netherlands
| | - Jaco J M Zwanenburg
- Department of Radiology, University Medical Center Utrecht, Postbox 85500, 3508 GA, Utrecht, The Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Postbox 85500, 3508 GA, Utrecht, The Netherlands
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171
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Dieleman N, van der Kolk AG, Zwanenburg JJM, Brundel M, Harteveld AA, Biessels GJ, Visser F, Luijten PR, Hendrikse J. Relations between location and type of intracranial atherosclerosis and parenchymal damage. J Cereb Blood Flow Metab 2016; 36:1271-80. [PMID: 26661234 PMCID: PMC4929701 DOI: 10.1177/0271678x15616401] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/21/2015] [Accepted: 09/28/2015] [Indexed: 02/02/2023]
Abstract
The aim of this study was to assess the relation between location and type of intracranial atherosclerosis (ICAS) and cortical microinfarcts (CMIs) and macroinfarcts in 18 patients presenting with ischemic stroke (n = 12) or transient ischemic attack (TIA) (n = 6) using 7 tesla MR imaging. The protocol included: 3D T2-weighted FLAIR and 3D T1-weighted Magnetization-Preparation Inversion Recovery Turbo Spin Echo sequence. ICAS lesions and infarcts were scored by two raters. The relation between ICAS lesions, calculated ratios of ICAS lesion characteristics, location, and infarcts were examined using linear regression analyses. A total number of 75 ICAS lesions (all patients), 101 CMIs (78% of patients), and 31 macroinfarcts (67% of patients) were found. Seventy-six and sixty-five percent of the CMIs and macroinfarcts, respectively, were found in the same vascular territory as the ICAS lesions (p = 0.977, p = 0.167, respectively). A positive correlation existed between the number of macroinfarcts and CMIs (p < 0.05). In patients with macroinfarcts, we found more concentric (p < 0.01) and diffuse (p < 0.05) type of ICAS lesions. A high prevalence of brain tissue lesions, both macroinfarcts and CMIs, were found in patients with ICAS. Macroinfarcts were found to be related to specific ICAS lesion types. The type of ICAS lesion seems to be promising as a marker for ICAS patients at higher risk of future infarcts.
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Affiliation(s)
- Nikki Dieleman
- Department of Radiology, University Medical Center Utrecht, the Netherlands
| | | | - Jaco J M Zwanenburg
- Department of Radiology, University Medical Center Utrecht, the Netherlands Image Sciences Institute, University Medical Center Utrecht, the Netherlands
| | - Manon Brundel
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Anita A Harteveld
- Department of Radiology, University Medical Center Utrecht, the Netherlands
| | - Geert J Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Fredy Visser
- Department of Radiology, University Medical Center Utrecht, the Netherlands Philips Healthcare, Best, the Netherlands
| | - Peter R Luijten
- Department of Radiology, University Medical Center Utrecht, the Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, the Netherlands
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172
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Dieleman N, Yang W, Abrigo JM, Chu WCW, van der Kolk AG, Siero JCW, Wong KS, Hendrikse J, Chen XY. Magnetic Resonance Imaging of Plaque Morphology, Burden, and Distribution in Patients With Symptomatic Middle Cerebral Artery Stenosis. Stroke 2016; 47:1797-802. [PMID: 27301944 PMCID: PMC4927221 DOI: 10.1161/strokeaha.116.013007] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/19/2016] [Indexed: 01/13/2023]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— Intracranial atherosclerosis is a major cause of ischemic stroke worldwide. Intracranial vessel wall imaging is an upcoming field of interest to assess intracranial atherosclerosis. In this study, we investigated total intracranial plaque burden in patients with symptomatic middle cerebral artery stenosis, assessed plaque morphological features, and compared features of symptomatic and asymptomatic lesions using a 3T vessel wall sequence. Methods— Nineteen consecutive Chinese patients with ischemic stroke and transient ischemic attack (mean age: 67 years; 7 females) with a middle cerebral artery stenosis were scanned at 3T magnetic resonance imaging; the protocol included a time-of-flight magnetic resonance angiography and the T1-weighted volumetric isotropically reconstructed turbo spin echo acquisition sequence before and after (83%) contrast administration. Chi-square tests were used to assess associations between different plaque features. Statistical significance was set at P<0.05. Results— Vessel wall lesions were identified in 18 patients (95%), totaling 57 lesions in 494 segments (12% of segments). Lesions were located primarily in the anterior circulation (82%). Eccentric lesions were associated with a focal thickening pattern and concentric lesions with a diffuse thickening pattern (P<0.001). When differentiating between asymptomatic and symptomatic lesions, an association (P<0.05) was found between eccentricity and asymptomatic lesions, but not for enhancement or a specific thickening pattern. Symptomatic lesions did not have any specific morphological features. Conclusions— Our results lead to a 2-fold conclusion: (1) The classification system of both thickening pattern and distribution of the lesion can be simplified by using distribution pattern only and (2) differentiation between symptomatic and asymptomatic atherosclerotic lesions was possible using intracranial vessel wall imaging.
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Affiliation(s)
- Nikki Dieleman
- From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wenjie Yang
- From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jill M Abrigo
- From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Winnie Chiu Wing Chu
- From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Anja G van der Kolk
- From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jeroen C W Siero
- From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ka Sing Wong
- From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jeroen Hendrikse
- From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Xiang Yan Chen
- From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
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173
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Hwang J, Chung JW, Cha J, Bang OY, Chung CS, Lee KH, Kim GM. Selective Application of High-Resolution 3 T MRI in the Evaluation of Intracranial Vertebral Artery Dissection. J Neuroimaging 2016; 27:71-77. [DOI: 10.1111/jon.12368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/25/2016] [Accepted: 05/01/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jaechun Hwang
- Department of Neurology, Samsung Changwon Hospital; Sungkyunkwan University School of Medicine; Changwon South Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Jihoon Cha
- Department of Radiology, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Chin-Sang Chung
- Department of Neurology, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Kwang Ho Lee
- Department of Neurology, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
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174
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de Havenon A, Chung L, Park M, Mossa-Basha M. Intracranial vessel wall MRI: a review of current indications and future applications. ACTA ACUST UNITED AC 2016. [DOI: 10.1186/s40809-016-0021-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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175
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Alexander MD, Yuan C, Rutman A, Tirschwell DL, Palagallo G, Gandhi D, Sekhar LN, Mossa-Basha M. High-resolution intracranial vessel wall imaging: imaging beyond the lumen. J Neurol Neurosurg Psychiatry 2016; 87:589-97. [PMID: 26746187 PMCID: PMC5504758 DOI: 10.1136/jnnp-2015-312020] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/23/2015] [Indexed: 01/21/2023]
Abstract
Accurate and timely diagnosis of intracranial vasculopathies is important due to significant risk of morbidity with delayed and/or incorrect diagnosis both from the disease process as well as inappropriate therapies. Conventional vascular imaging techniques for analysis of intracranial vascular disease provide limited information since they only identify changes to the vessel lumen. New advanced MR intracranial vessel wall imaging (IVW) techniques can allow direct characterisation of the vessel wall. These techniques can advance diagnostic accuracy and may potentially improve patient outcomes by better guided treatment decisions in comparison to previously available invasive and non-invasive techniques. While neuroradiological expertise is invaluable in accurate examination interpretation, clinician familiarity with the application and findings of the various vasculopathies on IVW can help guide diagnostic and therapeutic decision-making. This review article provides a brief overview of the technical aspects of IVW and discusses the IVW findings of various intracranial vasculopathies, differentiating characteristics and indications for when this technique can be beneficial in patient management.
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Affiliation(s)
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Aaron Rutman
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - David L Tirschwell
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Gerald Palagallo
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Dheeraj Gandhi
- Department of Radiology, Neurology and Neurosurgery, University of Maryland, Baltimore, Maryland, USA
| | - Laligam N Sekhar
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, USA
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Chen Z, Liu AF, Chen H, Yuan C, He L, Zhu Y, Guan M, Jiang WJ, Zhao X. Evaluation of basilar artery atherosclerotic plaque distribution by 3D MR vessel wall imaging. J Magn Reson Imaging 2016; 44:1592-1599. [PMID: 27249041 DOI: 10.1002/jmri.25296] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/13/2016] [Accepted: 04/13/2016] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Basilar artery (BA) atherosclerosis is an important cause of perforator stroke in the brainstem due to plaque involvement of the perforator ostia in BA dorsal or lateral walls. Therefore, to acquire information on plaque distribution is important to better understand and prevent the perforator stroke. This study aimed to comprehensively evaluate BA plaque distribution with 3D magnetic resonance imaging (MRI) vessel wall imaging. MATERIALS AND METHODS Consecutive patients with cerebrovascular symptoms and stenosis or irregular luminal surface of BA were recruited and underwent BA 3D proton density-weighted volume isotropic turbo spin echo acquisition (VISTA) imaging at 3T. The cross-sectional and longitudinal distribution of BA plaque were analyzed with a custom-developed tool. RESULTS In all, 85 BA plaques were detected in 61 recruited patients. For cross-sectional distribution, the prevalence of plaque involvement in the ventral, left, dorsal, and right quadrant of BA wall was 74.1%, 70.6%, 67.1%, and 62.4%, respectively. Of the 85 plaques, 17.7% involved one quadrant and 82.3% involved two or more quadrants. The most severe plaque region was more commonly situated at lateral walls (66.1%) as compared to ventral (23.2%, P < 0.001) and dorsal walls (10.6%, P < 0.001). Longitudinally, plaques were more frequently found to occur at BA segment distal than proximal to anterior inferior cerebellar artery (AICA) (63.5% vs. 36.5%). CONCLUSION Taking advantage of 3D MR vessel wall imaging, BA plaques were found to more likely affect lateral walls and form in BA distal to AICA, where most perforators originate, suggesting that it might be useful to characterize BA plaque distribution before aggressive treatment for prevention of perforator stroke. J. Magn. Reson. Imaging 2016;44:1592-1599.
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Affiliation(s)
- Zhensen Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Ao-Fei Liu
- New Era Stroke Care and Research Institute, General Hospital of the PLA Rocket Force, Beijing, China
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China.,Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Le He
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Yandong Zhu
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Maobin Guan
- Department of Radiology, Yangzhou First People's Hospital, Yangzhou, China
| | - Wei-Jian Jiang
- New Era Stroke Care and Research Institute, General Hospital of the PLA Rocket Force, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
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177
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Singhal AB, Topcuoglu MA, Fok JW, Kursun O, Nogueira RG, Frosch MP, Caviness VS. Reversible cerebral vasoconstriction syndromes and primary angiitis of the central nervous system: clinical, imaging, and angiographic comparison. Ann Neurol 2016; 79:882-94. [DOI: 10.1002/ana.24652] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/22/2016] [Accepted: 03/27/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Aneesh B. Singhal
- Massachusetts General Hospital and Harvard Medical School; Boston MA
| | - Mehmet A. Topcuoglu
- Massachusetts General Hospital and Harvard Medical School; Boston MA
- Neurology Department; Hacettepe University Hospitals; Ankara Turkey
| | - Joshua W. Fok
- Department of Medicine; Yan Chai Hospital; Hong Kong China
| | - Oguzhan Kursun
- Neurology Clinic; Ankara Numune Education and Research Hospital; Ankara Turkey
| | - Raul G. Nogueira
- Grady Memorial Hospital and Emory University School of Medicine; Atlanta GA
| | - Matthew P. Frosch
- Massachusetts General Hospital and Harvard Medical School; Boston MA
| | - Verne S. Caviness
- Massachusetts General Hospital and Harvard Medical School; Boston MA
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178
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Abstract
Intracranial vessel wall magnetic resonance imaging (VW-MRI) can be a useful diagnostic technique in patients with ischemic stroke and subarachnoid hemorrhage. Unlike conventional vascular imaging that depicts only the vessel lumen, VW-MRI allows visualization of pathology in the arterial wall itself. The ability to image the arterial wall is useful, as many pathological processes reside within the wall and only secondarily affect the lumen. In this review, we will present 6 clinical uses for intracranial wall imaging to highlight the versatility of this technique.
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179
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High-resolution intracranial vessel wall imaging using 3D CUBE T1 weighted sequence. Eur J Radiol 2016; 85:803-7. [DOI: 10.1016/j.ejrad.2016.01.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 01/12/2016] [Accepted: 01/17/2016] [Indexed: 11/22/2022]
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180
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Jiang Y, Zhu C, Peng W, Degnan AJ, Chen L, Wang X, Liu Q, Wang Y, Xiang Z, Teng Z, Saloner D, Lu J. Ex-vivo imaging and plaque type classification of intracranial atherosclerotic plaque using high resolution MRI. Atherosclerosis 2016; 249:10-6. [PMID: 27062404 DOI: 10.1016/j.atherosclerosis.2016.03.033] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS Recent development of high resolution MRI techniques have enabled imaging of intracranial atherosclerotic plaque in vivo. However, identifying plaque composition remains challenging given the small size and the lack of histological validation. This study aims to quantify the relaxation times of intracranial plaque components ex vivo at 3 T and to determine whether multi-contrast MRI could classify intracranial plaque according to the American Heart Association classification with histological validation. METHODS A total of 53 intracranial arteries with atherosclerotic plaques from 20 cadavers (11 male, age 73.8 ± 10.9) were excised. Quantitative T1/T2/T2* mapping sequences and multi-contrast fast-spin echo sequences (T1, T2, proton-density weighted and short time inversion recovery) were acquired. Plaque components including: fibrous cap, lipid core, fibrous tissue, calcification, and healthy wall were segmented on histology, and their relaxation times were derived from quantitative images. Two radiologists independently classified plaque type blinded to the histology results. RESULTS Relaxation times of plaque components are distinct and different. T2 and T2* values of lipid core are lower than fibrous cap (p = 0.026 & p < 0.0001), but are comparable with fibrous tissue and healthy wall (p = 0.76 & p = 0.42). MRI reliably classified plaque type compared with histology (κ = 0.69) with an overall accuracy of 80.7%. The sensitivity and specificity using MRI to identify fibro-lipid atheroma (type IV-V) was 94.8% and 77.1%, respectively. Inter-observer agreement was excellent (κ = 0.77). CONCLUSION Intracranial plaque components have distinct and different relaxation times at 3 T. High-resolution MRI is able to characterize intracranial plaque composition and classify plaque types ex vivo at 3 T.
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Affiliation(s)
| | - Chengcheng Zhu
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA.
| | - Wenjia Peng
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Andrew J Degnan
- Department of Radiology, University of Pittsburgh, Pittsburgh, USA
| | - Luguang Chen
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Xinrui Wang
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Qi Liu
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Yang Wang
- Department of Pathology, Changhai Hospital, Shanghai, China
| | - Zhenzhen Xiang
- Department of Pathology, Changhai Hospital, Shanghai, China
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - David Saloner
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - Jianping Lu
- Department of Radiology, Changhai Hospital, Shanghai, China.
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181
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Arai D, Satow T, Komuro T, Kobayashi A, Nagata H, Miyamoto S. Evaluation of the Arterial Wall in Vertebrobasilar Artery Dissection Using High-Resolution Magnetic Resonance Vessel Wall Imaging. J Stroke Cerebrovasc Dis 2016; 25:1444-50. [PMID: 27017283 DOI: 10.1016/j.jstrokecerebrovasdis.2016.01.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 01/21/2016] [Accepted: 01/31/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND High-resolution magnetic resonance vessel wall imaging (HRMR-VWI) has been used to explore vascular diseases such as vasculitis and vulnerable plaque of intracranial arteries. Although vessel wall inflammation is suspected as one of the causes of cerebral arterial dissection, there have been few reports regarding the application of HRMR-VWI to arterial dissection. We have therefore evaluated the efficacy of HRMR-VWI in patients with vertebrobasilar artery dissection. METHODS HRMR-VWI was performed on 5 patients who had been diagnosed with nonhemorrhagic vertebrobasilar artery dissection. RESULT Four patients exhibited vessel wall enhancement on HRMR-VWI, the range of which corresponded with the dissection sites identified by cerebral angiogram, magnetic resonance imaging, or magnetic resonance angiography. The enhancements observed in all cases were extensive as compared with the findings of conventional angiography. CONCLUSION HRMR-VWI is thought to elucidate the condition of the affected vessel wall more in detail as compared with conventional methods.
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Affiliation(s)
- Daisuke Arai
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Neurosurgery, Nagahama City Hospital, Nagahama, Japan.
| | - Takeshi Satow
- Department of Neurosurgery, Nagahama City Hospital, Nagahama, Japan
| | - Taro Komuro
- Department of Neurosurgery, Nagahama City Hospital, Nagahama, Japan
| | - Akira Kobayashi
- Department of Neurosurgery, Nagahama City Hospital, Nagahama, Japan
| | - Hirokazu Nagata
- Department of Neurosurgery, Nagahama City Hospital, Nagahama, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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182
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Natori T, Sasaki M, Miyoshi M, Ito K, Ohba H, Miyazawa H, Narumi S, Kabasawa H, Harada T, Terayama Y. Intracranial Plaque Characterization in Patients with Acute Ischemic Stroke Using Pre- and Post-Contrast Three-Dimensional Magnetic Resonance Vessel Wall Imaging. J Stroke Cerebrovasc Dis 2016; 25:1425-30. [PMID: 27021042 DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/14/2015] [Accepted: 12/27/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Magnetic resonance vessel wall imaging (VWI) techniques have been developed to assess atherosclerotic plaques in intracranial arteries, which are a cardinal cause of ischemic stroke. However, the clinical roles of plaque-related vulnerability and inflammation remain unclear. Hence, we evaluated plaque characteristics using VWI of the proximal middle cerebral artery (M1) in patients with acute ischemic stroke. METHODS We prospectively examined 30 consecutive patients with acute noncardioembolic stroke in the M1 territory using pre-/postcontrast T1-weighted (T1W) three-dimensional (3D) VWI with a 3-Tesla scanner. The contrast ratio (CR) and contrast enhancement of the plaques were measured bilaterally at M1. RESULTS Plaques were identified in the bilateral M1s of all patients, and no substantial stenosis existed. The M1 plaque CRs ipsilateral to the infarct (46.7%-67.9%) were significantly higher than the plaque CRs on the contralateral side (34.3%-69.4%), particularly in patients with lacunar infarcts (P <.01). In contrast, the occurrence of plaque enhancement was not different between the ipsilateral (20.0%) and contralateral (16.7%) sides. Further, the CRs in the nonlacunar group were significantly higher than the CRs in the lacunar group (P <.05), whereas enhanced plaques tended to be more frequent in the nonlacunar group, but this difference was not significant (P = .09). CONCLUSIONS T1W 3D-VWI revealed that the signal intensity of M1 plaques was significantly higher in the affected side and in nonlacunar-type infarcts of patients with acute stroke, suggesting that unstable plaques in the M1 can cause stroke events presumably due to atherothrombotic mechanisms.
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Affiliation(s)
- Tatsunori Natori
- Department of Neurology and Gerontology, Iwate Medical University, Japan.
| | - Makoto Sasaki
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Japan
| | | | - Kohei Ito
- Department of Neurology and Gerontology, Iwate Medical University, Japan
| | - Hideki Ohba
- Department of Neurology and Gerontology, Iwate Medical University, Japan
| | - Haruna Miyazawa
- Department of Neurology and Gerontology, Iwate Medical University, Japan
| | - Shinsuke Narumi
- Department of Neurology and Gerontology, Iwate Medical University, Japan
| | | | - Taisuke Harada
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Japan
| | - Yasuo Terayama
- Department of Neurology and Gerontology, Iwate Medical University, Japan
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183
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Oeinck M, Rozeik C, Wattchow J, Meckel S, Schlageter M, Beeskow C, Reinhard M. Why a standard contrast-enhanced MRI might be useful in intracranial internal carotid artery stenosis. Neuroradiol J 2016; 29:208-12. [PMID: 26988083 DOI: 10.1177/1971400916638354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In patients with ischemic stroke of unknown cause cerebral vasculitis is a rare but relevant differential diagnosis, especially when signs of intracranial artery stenosis are found and laboratory findings show systemic inflammation. In such cases, high-resolution T1w vessel wall magnetic resonance imaging (MRI; 'black blood' technique) at 3 T is preferentially performed, but may not be available in every hospital. We report a case of an 84-year-old man with right hemispheric transient ischemic attack and signs of distal occlusion in the right internal carotid artery (ICA) in duplex sonography. Standard MRI with contrast agent pointed the way to the correct diagnosis since it showed an intramural contrast uptake in the right ICA and both vertebral arteries. Temporal artery biopsy confirmed the suspected diagnosis of a giant cell arteritis and dedicated vessel wall MRI performed later supported the suspected intracranial large artery inflammation. Our case also shows that early diagnosis and immunosuppressive therapy may not always prevent disease progression, as our patient suffered several infarcts in the left middle cerebral artery (MCA) territory with consecutive high-grade hemiparesis of the right side within the following four months.
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Affiliation(s)
- Maximilian Oeinck
- Department of Neurology, Neurocenter, University of Freiburg, Germany
| | | | - Jens Wattchow
- Department of Neurology, Kreiskliniken Lörrach, Germany
| | - Stephan Meckel
- Department of Neuroradiology, Neurocenter, University of Freiburg, Germany
| | | | | | - Matthias Reinhard
- Department of Neurology, Neurocenter, University of Freiburg, Germany
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184
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Zhu C, Haraldsson H, Tian B, Meisel K, Ko N, Lawton M, Grinstead J, Ahn S, Laub G, Hess C, Saloner D. High resolution imaging of the intracranial vessel wall at 3 and 7 T using 3D fast spin echo MRI. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2016; 29:559-70. [DOI: 10.1007/s10334-016-0531-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/27/2016] [Accepted: 02/01/2016] [Indexed: 11/29/2022]
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185
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Fan Z, Yang Q, Deng Z, Li Y, Bi X, Song S, Li D. Whole-brain intracranial vessel wall imaging at 3 Tesla using cerebrospinal fluid-attenuated T1-weighted 3D turbo spin echo. Magn Reson Med 2016; 77:1142-1150. [PMID: 26923198 DOI: 10.1002/mrm.26201] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 01/20/2016] [Accepted: 02/12/2016] [Indexed: 11/11/2022]
Abstract
PURPOSE Although three-dimensional (3D) turbo spin echo (TSE) with variable flip angles has proven to be useful for intracranial vessel wall imaging, it is associated with inadequate suppression of cerebrospinal fluid (CSF) signals and limited spatial coverage at 3 Tesla (T). This work aimed to modify the sequence and develop a protocol to achieve whole-brain, CSF-attenuated T1 -weighted vessel wall imaging. METHODS Nonselective excitation and a flip-down radiofrequency pulse module were incorporated into a commercial 3D TSE sequence. A protocol based on the sequence was designed to achieve T1 -weighted vessel wall imaging with whole-brain spatial coverage, enhanced CSF-signal suppression, and isotropic 0.5-mm resolution. Human volunteer and pilot patient studies were performed to qualitatively and quantitatively demonstrate the advantages of the sequence. RESULTS Compared with the original sequence, the modified sequence significantly improved the T1 -weighted image contrast score (2.07 ± 0.19 versus 3.00 ± 0.00, P = 0.011), vessel wall-to-CSF contrast ratio (0.14 ± 0.16 versus 0.52 ± 0.30, P = 0.007) and contrast-to-noise ratio (1.69 ± 2.18 versus 4.26 ± 2.30, P = 0.022). Significant improvement in vessel wall outer boundary sharpness was observed in several major arterial segments. CONCLUSIONS The new 3D TSE sequence allows for high-quality T1 -weighted intracranial vessel wall imaging at 3 T. It may potentially aid in depicting small arteries and revealing T1 -mediated high-signal wall abnormalities. Magn Reson Med 77:1142-1150, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Zhaoyang Fan
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Qi Yang
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Radiology, Xuanwu Hospital, Beijing, China
| | - Zixin Deng
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Yuxia Li
- Department of Neurology, Xuanwu Hospital, Beijing, China
| | - Xiaoming Bi
- MR R&D, Siemens Healthcare, Los Angeles, California, USA
| | - Shlee Song
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Bioengineering, University of California, Los Angeles, California, USA
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186
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Kontzialis M, Wasserman BA. Intracranial vessel wall imaging: current applications and clinical implications. ACTA ACUST UNITED AC 2016. [DOI: 10.1186/s40809-016-0014-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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187
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Kim JM, Jung KH, Sohn CH, Moon J, Shin JH, Park J, Lee SH, Hee Han M, Roh JK. Intracranial plaque enhancement from high resolution vessel wall magnetic resonance imaging predicts stroke recurrence. Int J Stroke 2016; 11:171-9. [DOI: 10.1177/1747493015609775] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Intracranial atherosclerosis is associated with frequent stroke recurrence. High resolution vessel wall magnetic resonance imaging (HRMRI) can provide atheroma information related to its vulnerability. Aims We performed HRMRI in stroke patients with intracranial atherosclerosis to determine whether plaque characteristics from vessel wall imaging can predict future stroke recurrence. Methods Between July 2011 and June 2013, acute stroke patients with symptomatic intracranial atherosclerosis were prospectively enrolled and 3-tesla HRMRI was performed on the relevant artery. The plaque enhancement was visually determined from T1 post-gadolinium enhancement image. Stroke recurrence was monitored after index event and multivariate Cox proportional hazards model was constructed to identify factors related to future stroke recurrence. Results A total of 138 patients were included with a median follow-up of 18 months. There were 39 stroke recurrences. Plaque enhancement was detected in 108 patients (78.3%), and 37 of them experienced stroke recurrence. Among 30 stroke patients without plaque enhancement, two patients experienced stroke recurrence. Kaplan–Meier curves demonstrated a significant difference in event free survival between the patients with plaque enhancement and those patients without plaque enhancement (event rates at year 1: 30.3% vs. 6.8%, log-rank test, p = 0.004). Multivariate Cox-regression analysis showed that the plaque enhancement from HRMRI was independently associated with stroke recurrence (hazard ratio: 7.42, 95% confidence interval: 1.74–31.75, p = 0.007). Conclusion Intracranial plaque enhancement from HRMRI is associated with stroke recurrence among the patients with symptomatic intracranial atherosclerosis.
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Affiliation(s)
- Jeong-Min Kim
- Department of Neurology, Chung-Ang University Hospital, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Chul-Ho Sohn
- Department of Radiology, Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Jangsup Moon
- Department of Neurology, Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Jung-Hwan Shin
- Department of Neurology, Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Jaeseok Park
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Seung-Hoon Lee
- Department of Neurology, Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Moon Hee Han
- Department of Radiology, Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Jae-Kyu Roh
- Department of Neurology, Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea
- Department of Neurology, The Armed Forces Capital Hospital, Gyeunggido, South Korea
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188
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Mossa-Basha M, Alexander M, Gaddikeri S, Yuan C, Gandhi D. Vessel wall imaging for intracranial vascular disease evaluation. J Neurointerv Surg 2016; 8:1154-1159. [PMID: 26769729 DOI: 10.1136/neurintsurg-2015-012127] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 12/19/2015] [Indexed: 11/04/2022]
Abstract
Accurate and timely diagnosis of intracranial vasculopathies is important owing to the significant risk of morbidity with delayed and/or incorrect diagnosis both from the disease process and inappropriate therapies. Conventional luminal imaging techniques for analysis of intracranial vasculopathies are limited to evaluation of changes in the vessel lumen. Vessel wall MRI techniques can allow direct characterization of pathologic changes of the vessel wall. These techniques may improve diagnostic accuracy and improve patient outcomes. Extracranial carotid vessel wall imaging has been extensively investigated in patients with atherosclerotic disease and has been shown to accurately assess plaque composition and identify vulnerable plaque characteristics that may predict stroke risk beyond luminal stenosis alone. This review provides a brief history of vessel wall MRI, an overview of the intracranial vessel wall MRI techniques, its applications, and imaging findings of various intracranial vasculopathies pertinent to the neurointerventionalist, neurologist, and neuroradiologist. We searched MEDLINE, PubMed, and Google for English publications containing any of the following terms: 'intracranial vessel wall imaging', 'intracranial vessel wall', and 'intracranial vessel wall MRI'.
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Affiliation(s)
- Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Matthew Alexander
- Department of Radiology, University of California-San Francisco, San Francisco, California, USA
| | - Santhosh Gaddikeri
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Dheeraj Gandhi
- Department of Radiology, Neurosurgery and Neurology, University of Maryland, Baltimore, Maryland, USA
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189
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Obusez EC, Jones SE, Hui F. Vessel wall MRI for suspected isolated basilar artery dissection. J Clin Neurosci 2016; 27:177-9. [PMID: 26765755 DOI: 10.1016/j.jocn.2015.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 11/13/2015] [Indexed: 10/22/2022]
Abstract
Isolated basilar artery dissection is an uncommon intracranial vasculopathy with a poor prognosis. Digital subtraction angiography is considered the definitive modality for diagnosis. Vessel wall MRI (VW-MRI) is an emerging non-invasive technique for assessing the structural integrity of intracranial vessel walls and lumina. Recently, a small number of studies have described the vessel wall patterns of intracranial artery dissection. However, studies on vessel wall imaging of isolated basilar artery dissection remain limited. We describe a patient with suspected isolated spontaneous basilar artery dissection diagnosed using VW-MRI.
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Affiliation(s)
- Emmanuel C Obusez
- Department of Neuroradiology, Imaging Institute, Cleveland Clinic, Mail Code L10, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Stephen E Jones
- Department of Neuroradiology, Imaging Institute, Cleveland Clinic, Mail Code L10, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Ferdinand Hui
- Division of Neuroradiology, The Johns Hopkins Hospital, Baltimore, MD, USA
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190
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Kim JS, Caplan LR. Vertebrobasilar Disease. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00026-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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191
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192
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Steven AJ, Milburn JM, Gulotta P, Gandhi D. Clinical Images: Vessel Wall Imaging in the Management of Subarachnoid Hemorrhage and Multiple Intracranial Aneurysms. Ochsner J 2016; 16:199-202. [PMID: 27660564 PMCID: PMC5024797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Affiliation(s)
- Andrew J Steven
- Department of Radiology, University of Maryland Medical System, Baltimore, MD
| | - James M Milburn
- Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA
| | - Paul Gulotta
- Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA
| | - Dheeraj Gandhi
- Department of Radiology, University of Maryland Medical System, Baltimore, MD
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193
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Bhogal P, Navaei E, Makalanda HLD, Brouwer PA, Sjöstrand C, Mandell DM, Lilja A. Intracranial vessel wall MRI. Clin Radiol 2015; 71:293-303. [PMID: 26711874 DOI: 10.1016/j.crad.2015.11.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 10/02/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Abstract
There are many different methods of imaging the intracranial arteries; however, the vast majority of currently used techniques are based on luminal imaging. Although this is useful, it does have limitations as many different pathological processes can produce the same appearance. Therefore, directly imaging the site of the pathology - the vessel wall itself - offers the hope of discriminating between different disease processes. In this review, we will discuss the current status of vessel wall magnetic resonance imaging alongside its potential usefulness in differentiating between various disease entities.
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Affiliation(s)
- P Bhogal
- Department of Neuroradiology, The Karolinska University Hospital, Stockholm 17176, Sweden.
| | - E Navaei
- Department of Neuroradiology, The Karolinska University Hospital, Stockholm 17176, Sweden
| | - H L D Makalanda
- Department of Interventional Neuroradiology, The Royal London Hospital, London E1 1BB, UK
| | - P A Brouwer
- Department of Neuroradiology, The Karolinska University Hospital, Stockholm 17176, Sweden
| | - C Sjöstrand
- Department of Neuroradiology, The Karolinska University Hospital, Stockholm 17176, Sweden
| | - D M Mandell
- Division of Neuroradiology, Department of Medical Imaging, University Health Network and the University of Toronto, Toronto, Canada
| | - A Lilja
- Department of Neuroradiology, The Karolinska University Hospital, Stockholm 17176, Sweden
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Yang WJ, Chen XY, Zhao HL, Niu CB, Xu Y, Wong KS, Ng HK. In Vitro Assessment of Histology Verified Intracranial Atherosclerotic Disease by 1.5T Magnetic Resonance Imaging: Concentric or Eccentric? Stroke 2015; 47:527-30. [PMID: 26628387 DOI: 10.1161/strokeaha.115.011086] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/21/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Clinical trial studies show that plaque eccentricity (symmetry) is among the plaque features that have been associated with more frequent cerebrovascular events. Plaque eccentricity of intracranial atherosclerotic disease is unclear because of lacking of cerebral artery specimens. METHODS 1.5T magnetic resonance imaging was performed in the postmortem brains to scan the cross sections of middle cerebral artery. Plaque eccentricity of histology-verified middle cerebral artery atherosclerosis was calculated on T1-weighted fat-suppressed sequence. RESULTS Validated by histology, concentric atherosclerotic plaques were identified in 46 middle cerebral arteries (63.9%) on magnetic resonance imaging and eccentric plaques in 26 arteries (26.1%). Eccentric plaques showed higher maximum wall thickness and lower minimum wall thickness than concentric plaques (both P<0.001). Plaque burden and brain infarctions were similar between concentric and eccentric plaques. CONCLUSIONS Intracranial atherosclerosis presents as eccentric or concentric in geometry, which may be not linked to intracranial plaque risk. Further in vivo imaging studies are needed to identify morphological features of intracranial plaques and to verify its association with brain infarctions.
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Affiliation(s)
- Wen-Jie Yang
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Faculty of Basic Medicine, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, Jilin, China (C.-B.N.); and Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, PR China (Y.X.)
| | - Xiang-Yan Chen
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Faculty of Basic Medicine, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, Jilin, China (C.-B.N.); and Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, PR China (Y.X.).
| | - Hai-Lu Zhao
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Faculty of Basic Medicine, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, Jilin, China (C.-B.N.); and Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, PR China (Y.X.)
| | - Chun-Bo Niu
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Faculty of Basic Medicine, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, Jilin, China (C.-B.N.); and Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, PR China (Y.X.)
| | - Yun Xu
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Faculty of Basic Medicine, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, Jilin, China (C.-B.N.); and Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, PR China (Y.X.)
| | - Ka-Sing Wong
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Faculty of Basic Medicine, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, Jilin, China (C.-B.N.); and Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, PR China (Y.X.)
| | - Ho-Keung Ng
- From the Department of Medicine and Therapeutics (W.-J.Y., X.-Y.C., K.-S.W.) and Department of Anatomical and Cellular Pathology (H.-K.N.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Faculty of Basic Medicine, Guilin Medical University, Guilin, China (H.-L.Z.); Department of Pathology, China-Japan Union Hospital Affiliated to Jilin University, Jilin, China (C.-B.N.); and Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, PR China (Y.X.)
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195
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Perren F, Vargas MI, Kargiotis O. Etiology of Intracranial Arterial Stenosis: Are Transcranial Color-Coded Duplex Ultrasound and 3T Black Blood MR Imaging Complementary? J Neuroimaging 2015; 26:426-30. [PMID: 27040482 DOI: 10.1111/jon.12315] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 09/27/2015] [Accepted: 10/18/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In order to differentiate between the different causes of intracranial stenosis, we compared the diagnostic results of transcranial color-coded duplex (TCCD) sonography with the recently developed 3D high-resolution black blood MR sequence. METHODS We studied retrospectively 20 patients referred to our hospital after acute ischemic stroke who were diagnosed with intracranial stenosis and in whom a repetitive TCCD and a 3D MR T1 FAT SAT (black blood) sequence at 3T (TR/TE 350/20 ms, FOV 160×182×120 mm, 0.4×0.4×0.4 size of pixel, 300 slices, Fat Sat spair, acquisition time 6 minutes 14) were performed. Etiological diagnosis was based on one hand on the morphological aspect of the arterial wall (black blood T1 FAT SAT sequence) and on the hemodynamic aspect (TCCD) on the other hand. Analysis of black blood T1 FAT SAT MR sequence and TCCD agreement on the etiological diagnosis was performed using sign test. RESULTS TCCD was performed at admission and at least at two different intervals during follow-up. Eleven patients had diffuse intracranial arterial disease and nine had involvement of a single intracranial artery. Etiology of intracranial arterial stenosis included: atheromatosis, thrombosis, vasculitis and reversible vasoconstriction syndrome. There was 80% agreement (sign test P = .0059) between these two methods. CONCLUSIONS These two combined imaging techniques might be promising for the differentiation of arteriosclerotic changes from stenosis of another origin, especially when follow-up TCCD studies are completed early before a possible regression of the atherosclerotic plaque that might be observed 6 months after initial diagnosis.
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Affiliation(s)
- Fabienne Perren
- Department of Neurology, Neurovascular and Neurosonology Unit, University Hospital and Medical Faculty of Geneva, Geneva
| | - Maria I Vargas
- Department of Radiology, Neuroradiology Unit, University Hospital and Medical Faculty of Geneva, Geneva
| | - Odysseas Kargiotis
- Department of Neurology, Neurovascular and Neurosonology Unit, University Hospital and Medical Faculty of Geneva, Geneva
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Zhang L, Zhang N, Wu J, Zhang L, Huang Y, Liu X, Chung YC. High resolution three dimensional intracranial arterial wall imaging at 3 T using T1 weighted SPACE. Magn Reson Imaging 2015; 33:1026-1034. [DOI: 10.1016/j.mri.2015.06.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 05/07/2015] [Accepted: 06/20/2015] [Indexed: 10/23/2022]
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Wall thickening pattern in atherosclerotic basilar artery stenosis. Neurol Sci 2015; 37:269-76. [PMID: 26520844 DOI: 10.1007/s10072-015-2404-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/17/2015] [Indexed: 10/22/2022]
Abstract
Our aim was to investigate wall thickening (WT) pattern of atherosclerotic basilar artery stenosis with three-dimensional volumetric isotropic turbo spin echo acquisition (3D VISTA), and the relationship with clinical characteristics. Twenty consecutive patients with atherosclerotic basilar artery stenosis were prospectively enrolled. All cross-sectional slices on VISTA images of basilar arteries were assessed, and classified as eccentric or concentric WT. Clinical characteristics and degree of stenosis were compared between the patients with different wall WT pattern. Wall abnormalities were identified in 568 cross-sectional slices in basilar arteries of 20 patients including eccentric WT in 497 (87.5 %) slices, and concentric WT in 71 (12.5 %) slices. In 11 of 20 patients, all the cross-sectional slices (293 slices) showed eccentric WT. In 9 of 20 patients, the cross-sectional slices (275 slices) showed both eccentric WT (204 slices, 74.2 %) and concentric WT (71 slices, 25.8 %). No lesion showed only concentric WT. At the slices of maximum luminal narrowing sites, only one patient showed concentric WT. Symptomatic stenosis was more common in the patients with mixed WT (eccentric and concentric), compared to patients with only eccentric WT (100 vs 54.5 %, p = 0.038). Atherosclerotic basilar artery stenosis could show both eccentric and concentric WT based on each slice analysis. Concentric WT was found in near half of the patients, but tended to locate in minimal slices. No lesion was entirely concentric. Lesions with mixed WT (concentric and eccentric) might represent advanced atherosclerosis with high risk of ischemic event.
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Xu P, Lv L, Li S, Ge H, Rong Y, Hu C, Xu K. Use of high-resolution 3.0-T magnetic resonance imaging to characterize atherosclerotic plaques in patients with cerebral infarction. Exp Ther Med 2015; 10:2424-2428. [PMID: 26668651 DOI: 10.3892/etm.2015.2815] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 09/01/2015] [Indexed: 11/05/2022] Open
Abstract
The present study aimed to evaluate the utility of high-resolution magnetic resonance imaging (MRI) in the characterization of atherosclerotic plaques in patients with acute and non-acute cerebral infarction. High-resolution MRI of unilateral stenotic middle cerebral arteries was performed to evaluate the degree of stenosis, the wall and plaque areas, plaque enhancement patterns and lumen remodeling features in 15 and 17 patients with acute and non-acute cerebral infarction, respectively. No significant difference was identified in the vascular stenosis rate between acute and non-acute patients. Overall, plaque eccentricity was observed in 29 patients, including 13 acute and 16 non-acute cases, with no significant difference identified between these groups. The wall area of stenotic arteries and the number of cases with plaque enhancement were significantly greater in the acute patients, but no significant difference in plaque or lumen area was identified between the 2 patient groups. Lumen remodeling patterns of stenotic arteries significantly differed between the acute and non-acute patients; the former predominantly demonstrated positive remodeling, and the latter group demonstrated evidence of negative remodeling. In conclusion, patients with acute and non-acute cerebral infarction exhibit specific characteristics in stenotic arteries and plaques, which can be effectively evaluated by high-resolution MRI.
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Affiliation(s)
- Peng Xu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu 221006, P.R. China
| | - Lulu Lv
- Department of Computed Tomography and Magnetic Resonance Imaging, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Shaodong Li
- Department of Radiology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu 221006, P.R. China
| | - Haitao Ge
- Department of Radiology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu 221006, P.R. China
| | - Yutao Rong
- Department of Radiology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu 221006, P.R. China
| | - Chunfeng Hu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu 221006, P.R. China
| | - Kai Xu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu 221006, P.R. China
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Treatment strategies for dissecting aneurysms of the posterior cerebral artery. Acta Neurochir (Wien) 2015; 157:1633-43. [PMID: 26259621 DOI: 10.1007/s00701-015-2526-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Dissecting aneurysms of the posterior cerebral artery (PCA) are rare and difficult to treat because of their deep and unfamiliar locations and unusual shapes. Although several treatment modalities have been proposed, none have generated satisfying results. Our experiences with PCA-dissecting aneurysms are reviewed and the treatment strategies discussed. METHODS All consecutive patients with PCA-dissecting aneurysm who were treated in a tertiary referral hospital between January 1998 and March 2014 were identified by retrospective review. Their clinical characteristics, radiological findings, treatment modalities and outcomes were documented. RESULTS Of the 21 patients with 21 PCA-dissecting aneurysms, 9 had subarachnoid hemorrhage and 3 had acute infarction of the thalamus at presentation. The aneurysms involved P1 (n = 4), the P1-2 junction (n = 3), mid-P2 (n = 6), P2A (n = 3), P2P (n = 1) and the P2-3 junction (n = 4). The aneurysm shapes were as follows: fusiform (n = 12), partially thrombosed (n = 8) and blood blister-like aneurysms (n = 1). The mean size was 16.6 ± 9.7 mm. Parent artery occlusion (PAO) without bypass (n = 15), PAO with bypass (n = 2), stent-assisted endosaccular coiling (n = 3) and stent placement only (n = 1) were performed. All three patients who underwent stent-assisted endosaccular coiling and the single patient who underwent PAO without bypass developed aneurysm recurrence. Six of the ten patients who received a PAO without a balloon test occlusion (BTO) experienced PCA territory infarction, whereas only one of the five patients who received a PAO after passing the BTO experienced an infarction. CONCLUSIONS PAO for PCA-dissecting aneurysm was effective in preventing recurrence. In addition, BTO before PAO was helpful in identifying candidates who truly needed surgical revascularization.
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