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Huang LX, Wu XB, Liu YA, Guo X, Liu CC, Cai WQ, Wang SW, Luo B. High-resolution magnetic resonance vessel wall imaging in ischemic stroke and carotid artery atherosclerotic stenosis: A review. Heliyon 2024; 10:e27948. [PMID: 38571643 PMCID: PMC10987942 DOI: 10.1016/j.heliyon.2024.e27948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/02/2024] [Accepted: 03/08/2024] [Indexed: 04/05/2024] Open
Abstract
Ischemic stroke is a significant burden on human health worldwide. Carotid Atherosclerosis stenosis plays an important role in the comprehensive assessment and prevention of ischemic stroke patients. High-resolution vessel wall magnetic resonance imaging has emerged as a successful technique for assessing carotid atherosclerosis stenosis. This advanced imaging modality has shown promise in effectively displaying a wide range of characteristics associated with the condition, leading to a comprehensive evaluation. High-resolution vessel wall magnetic resonance imaging not only enables a comprehensive evaluation of the instability of carotid atherosclerosis stenosis plaques but also provides valuable information for understanding the pathogenesis and predicting the prognosis of ischemic stroke patients. The purpose of this article is to review the application of high-resolution magnetic resonance imaging in ischemic stroke and carotid atherosclerotic stenosis.
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Affiliation(s)
- Li-Xin Huang
- Department of Neurosurgery, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Xiao-Bing Wu
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi-Ao Liu
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Xin Guo
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Chi-Chen Liu
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Wang-Qing Cai
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Sheng-Wen Wang
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bin Luo
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
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Liu Y, Jiang Z, Yang X, Wang Y, Yang B, Fu Q. Engineering Nanoplatforms for Theranostics of Atherosclerotic Plaques. Adv Healthc Mater 2024:e2303612. [PMID: 38564883 DOI: 10.1002/adhm.202303612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/28/2024] [Indexed: 04/04/2024]
Abstract
Atherosclerotic plaque formation is considered the primary pathological mechanism underlying atherosclerotic cardiovascular diseases, leading to severe cardiovascular events such as stroke, acute coronary syndromes, and even sudden cardiac death. Early detection and timely intervention of plaques are challenging due to the lack of typical symptoms in the initial stages. Therefore, precise early detection and intervention play a crucial role in risk stratification of atherosclerotic plaques and achieving favorable post-interventional outcomes. The continuously advancing nanoplatforms have demonstrated numerous advantages including high signal-to-noise ratio, enhanced bioavailability, and specific targeting capabilities for imaging agents and therapeutic drugs, enabling effective visualization and management of atherosclerotic plaques. Motivated by these superior properties, various noninvasive imaging modalities for early recognition of plaques in the preliminary stage of atherosclerosis are comprehensively summarized. Additionally, several therapeutic strategies are proposed to enhance the efficacy of treating atherosclerotic plaques. Finally, existing challenges and promising prospects for accelerating clinical translation of nanoplatform-based molecular imaging and therapy for atherosclerotic plaques are discussed. In conclusion, this review provides an insightful perspective on the diagnosis and therapy of atherosclerotic plaques.
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Affiliation(s)
- Yuying Liu
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, 266021, China
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Zeyu Jiang
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, 266021, China
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Xiao Yang
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, 266021, China
| | - Yin Wang
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, 266021, China
| | - Bin Yang
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Qinrui Fu
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, 266021, China
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Zhang L, Pu T, Xu X, Raynald, Zheng S, Fu J, Yong Q, Zhang W, He W. Diagnostic feasibility of middle cerebral artery stenosis or occlusion evaluated by TCCS and CEUS: Repeatability, reproducibility, and diagnostic agreement with DSA. J Stroke Cerebrovasc Dis 2024; 33:107575. [PMID: 38232582 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/19/2023] [Accepted: 01/11/2024] [Indexed: 01/19/2024] Open
Abstract
AIM This study aimed to evaluate the feasibility of transcranial color-coded sonography (TCCS) and contrast-enhanced ultrasound (CEUS) in assessing middle cerebral artery (MCA) stem stenosis or occlusion compared to digital subtraction angiography (DSA). METHODS A total of 48 cases including 96 MCAs suspected stem stenosis or obstruction in the MCA were assessed by TCCS, CE-TCCS, and DSA. The diameters of the most severe stenosis (Ds), proximal normal artery (Dn), and diameter stenosis rate of MCA were measured using both the color doppler flow imaging (CDFI) modality of TCCS or CEUS and the CEUS imaging modality. The intraclass correlation coefficients (ICCs) and 95 % confidence intervals (CI) were evaluated, and a weighted Kappa value was used to evaluate the intra-observer agreement, inter-observer agreement, agreement between CDFI modality and DSA stenosis or occlusion, and agreement between CEUS imaging modality and DSA stenosis or occlusion. RESULTS The ICC results indicated excellent repeatability and reproducibility (all ICCs > 0.75; weighted Kappa values >0.81). Compared with DSA, the weighted Kappa values and 95 % CIs of stenosis (the first measurement was taken by two observers) of CDFI modality and CEUS imaging modality were 0.175 (0.041, 0.308) and 0.779 (0.570, 0.988) for observers A and 0.181 (0.046, 0.316) and 0.779 (0.570, 0.988) for observers B respectively. CONCLUSION This study indicates that inter- and intra-observer agreements were good for the direct method of measuring percentages of MCA stenosis by TCCS and CEUS. CEUS imaging modality is a new and reliable imaging modality approach to evaluate the MCAs stenosis and occlusion.
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Affiliation(s)
- Lei Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tianning Pu
- Department of comprehensive ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaotong Xu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University
| | - Raynald
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University
| | - Shuai Zheng
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jingjing Fu
- Department of comprehensive ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qiang Yong
- Ultrasonic Medical Diagnosis and treatment Center, Shunyi Women's & Children's Hospital of Beijing Children's Hospital, Capital Medical University
| | - Wei Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Han G, Fan X, Hong Y, Zhou L, Zhu Y, Feng F, Yao M, Ni J. Burden of dilated perivascular spaces in patients with moyamoya disease and moyamoya syndrome is related to middle cerebral artery stenosis. Front Neurol 2023; 14:1192646. [PMID: 37342781 PMCID: PMC10277612 DOI: 10.3389/fneur.2023.1192646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/09/2023] [Indexed: 06/23/2023] Open
Abstract
Background and objective The correlation between intracranial large artery disease and cerebral small vessel disease (CSVD) has become a noteworthy issue. Dilated perivascular spaces (dPVS) are an important marker of CSVD, of which cerebral atrophy has been regarded as one of the pathological mechanisms. DPVS has been found to be associated with vascular stenosis in patients with moyamoya disease (MMD), but the underlying mechanism remains unclear. The purpose of our study was to explore the correlation between the middle cerebral artery (MCA) stenosis and dPVS in the centrum semiovale (CSO-dPVS) in patients with MMD/moyamoya syndrome (MMS) and to determine whether brain atrophy plays a mediating role in this relationship. Methods A total of 177 patients were enrolled in a single-center MMD/MMS cohort. Images of their 354 cerebral hemispheres were divided into three groups according to dPVS burden: mild (dPVS 0-10), moderate (dPVS 11-20), and severe (dPVS > 20). The correlations among cerebral hemisphere volume, MCA stenosis, and CSO-dPVS were analyzed, adjusting for the confounding factors of age, gender, and hypertension. Results After adjustment for age, gender, and hypertension, the degree of MCA stenosis was independently and positively associated with ipsilateral CSO-dPVS burden (standardized coefficient: β = 0.247, P < 0.001). A stratified analysis found that the subgroup with a severe CSO-dPVS burden exhibited a significantly higher risk of severe stenosis of the MCA [p < 0.001, OR = 6.258, 95% CI (2.347, 16.685)]. No significant correlation between CSO-dPVS and ipsilateral hemisphere volume was found (p = 0.055). Conclusion In our MMD/MMS cohort, there was a clear correlation between MCA stenosis and CSO-dPVS burden, which may be a direct effect of large vessel stenosis, without a mediating role of brain atrophy.
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Affiliation(s)
- Guangsong Han
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoyuan Fan
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuehui Hong
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Lixin Zhou
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yicheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Ming Yao
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Ni
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Wang H, Shen L, Zhao C, Liu S, Wu G, Wang H, Wang B, Zhu J, Du J, Gong Z, Chai C, Xia S. The incomplete circle of Willis is associated with vulnerable intracranial plaque features and acute ischemic stroke. J Cardiovasc Magn Reson 2023; 25:23. [PMID: 37020230 PMCID: PMC10077703 DOI: 10.1186/s12968-023-00931-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 03/13/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND The circle of Willis (CoW) plays a significant role in intracranial atherosclerosis (ICAS). This study investigated the relationship between different types of CoW, atherosclerosis plaque features, and acute ischemic stroke (AIS). METHODS We investigated 97 participants with AIS or transient ischemic attacks (TIA) underwent pre- and post-contrast 3T vessel wall cardiovascular magnetic resonance within 7 days of the onset of symptoms. The culprit plaque characteristics (including enhancement grade, enhancement ratio, high signal in T1, irregularity of plaque surface, and normalized wall index), and vessel remodeling (including arterial remodeling ratio and positive remodeling) for lesions were evaluated. The anatomic structures of the anterior and the posterior sections of the CoW (A-CoW and P-CoW) were also evaluated. The plaque features were compared among them. The plaque features were also compared between AIS and TIA patients. Finally, univariate and multivariate regression analysis was performed to evaluate the independent risk factors for AIS. RESULT Patients with incomplete A-CoW showed a higher plaque enhancement ratio (P = 0.002), enhancement grade (P = 0.01), and normalized wall index (NWI) (P = 0.018) compared with the patients with complete A-CoW. A higher proportion of patients with incomplete symptomatic P-CoW demonstrated more culprit plaques with high T1 signals (HT1S) compared with those with complete P-CoW (P = 0.013). Incomplete A-CoW was associated with a higher enhancement grade of the culprit plaques [odds ratio (OR):3.84; 95% CI: 1.36-10.88, P = 0.011], after adjusting for clinical risk factors such as age, sex, smoking, hypertension, hyperlipemia, and diabetes mellitus. Incomplete symptomatic P-CoW was associated with a higher probability of HT1S (OR:3.88; 95% CI: 1.12-13.47, P = 0.033), after adjusting for clinical risk factors such as age, sex, smoking, hypertension, hyperlipemia, and diabetes mellitus. Furthermore, an irregularity of the plaque surface (OR: 6.24; 95% CI: 2.25-17.37, P < 0.001), and incomplete symptomatic P-CoW (OR: 8.03, 95% CI: 2.43-26.55, P = 0.001) were independently associated with AIS. CONCLUSIONS This study demonstrated that incomplete A-CoW was associated with enhancement grade of the culprit plaque, and incomplete symptomatic side P-CoW was associated with the presence of HT1S of culprit plaque. Furthermore, an irregularity of plaque surface and incomplete symptomatic side P-CoW were associated with AIS.
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Affiliation(s)
- Huiying Wang
- The School of Medicine, Nankai University, Tianjin, 300071, China
| | - Lianfang Shen
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, 300192, China
| | - Chenxi Zhao
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, 300192, China
| | - Song Liu
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Gemuer Wu
- Department of Radiology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010000, China
| | - Huapeng Wang
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, 300192, China
| | - Beini Wang
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, 300192, China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthineers Ltd., Beijing, 100102, China
| | - Jixiang Du
- Department of Neurology, School of Medicine, Tianjin First Central Hospital, Nankai University, Tianjin, 300192, China
| | - Zhongying Gong
- Department of Neurology, School of Medicine, Tianjin First Central Hospital, Nankai University, Tianjin, 300192, China.
| | - Chao Chai
- Department of Radiology, School of Medicine, Tianjin First Central Hospital, Nankai University, Tianjin, 300192, China.
- Tianjin Institute of Imaging Medicine, Tianjin, 300192, China.
| | - Shuang Xia
- Department of Radiology, School of Medicine, Tianjin First Central Hospital, Nankai University, Tianjin, 300192, China.
- Tianjin Institute of Imaging Medicine, Tianjin, 300192, China.
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Assessment of the degree of arterial stenosis in intracranial atherosclerosis using 3D high-resolution MRI: comparison with time-of-flight MRA, contrast-enhanced MRA, and DSA. Clin Radiol 2023; 78:e63-e70. [PMID: 36307233 DOI: 10.1016/j.crad.2022.08.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/03/2022] [Accepted: 08/16/2022] [Indexed: 01/18/2023]
Abstract
AIM To compare the accuracy of three-dimensional (3D) high-resolution (HR) magnetic resonance imaging (MRI), time-of-flight magnetic resonance angiography (TOF-MRA), contrast-enhanced magnetic resonance angiography (CE-MRA), and digital subtraction angiography (DSA) in measuring the degree of stenosis in intracranial atherosclerosis. MATERIALS AND METHODS All patients with intracranial artery ischaemic events underwent HR-MRI, TOF-MRA, and CE-MRA analysis, and some of these patients underwent DSA examination. The correlation between different methods for measuring the degree of lumen stenosis was analysed. The accuracy of HR-MRI, TOF-MRA, and CE-MRA was evaluated and compared with that of DSA. RESULTS A total of 189 arterial stenoses were identified in 93 patients. Of these, 72 patients with 142 arterial stenoses underwent DSA examination. A very strong correlation between HR-MRI and CE-MRA measurements was shown (r=0.839, p<0.0001). The correlation between HR-MRI and TOF-MRA measurements was strong (r=0.720, p<0.0001). A very strong correlation between HR-MRI and DSA measurements was found (r=0.864, p<0.0001), and a similar correlation was observed between CE-MRA, and DSA measurements (r=0.843, p<0.0001). The correlation between TOF-MRA and DSA measurements was strong (r=0.686, p<0.0001). There was substantial agreement between HR-MRI and DSA measurements (K = 0.772) and between CE-MRA, and DSA measurements (K = 0.734) that was slightly higher than the agreement between TOF-MRA and DSA measurements (K = 0.636). CONCLUSION HR-MRI can accurately measure stenosis (especially for moderate and severe stenosis) in intracranial atherosclerosis by direct visualisation of the vessel lumen and steno-occlusive plaque.
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Fakih R, Varon Miller A, Raghuram A, Sanchez S, Miller JM, Kandemirli S, Zhu C, Shaban A, Leira EC, Samaniego EA. High resolution 7T MR imaging in characterizing culprit intracranial atherosclerotic plaques. Interv Neuroradiol 2022:15910199221145760. [PMID: 36573263 DOI: 10.1177/15910199221145760] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Current imaging modalities underestimate the severity of intracranial atherosclerotic disease (ICAD). High resolution vessel wall imaging (HR-VWI) MRI is a powerful tool in characterizing plaques. We aim to show that HR-VWI MRI is more accurate at detecting and characterizing intracranial plaques compared to digital subtraction angiography (DSA), time-of-flight (TOF) MRA, and computed tomography angiogram (CTA). METHODS Patients with symptomatic ICAD prospectively underwent 7T HR-VWI. We calculated: degree of stenosis, plaque burden (PB), and remodeling index (RI). The sensitivity of detecting a culprit plaque for each modality as well as the correlations between different variables were analyzed. Interobserver agreement on the determination of a culprit plaque on every imaging modality was evaluated. RESULTS A total of 44 patients underwent HR-VWI. Thirty-four patients had CTA, 18 TOF-MRA, and 18 DSA. The sensitivity of plaque detection was 88% for DSA, 78% for TOF-MRA, and 76% for CTA. There's significant positive correlation between PB and degree of stenosis on HR-VWI MRI (p < 0.001), but not between PB and degree of stenosis in DSA (p = 0.168), TOF-MRA (p = 0.144), and CTA (p = 0.253). RI had a significant negative correlation with degree of stenosis on HR-VWI MRI (p = 0.003), but not on DSA (p = 0.783), TOF-MRA (p = 0.405), or CTA (p = 0.751). The best inter-rater agreement for culprit plaque detection was with HR-VWI (p = 0.001). CONCLUSIONS The degree of stenosis measured by intra-luminal techniques does not fully reflect the true extent of ICAD. HR-VWI is a more accurate tool in characterizing atherosclerotic plaques and may be the default imaging modality in clinical practice.
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Affiliation(s)
- Rami Fakih
- Department of Neurology, 21782The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Alberto Varon Miller
- Department of Neurology, 21654University of Connecticut Health Center, Farmington, CT, USA
| | - Ashrita Raghuram
- Department of Neurology, 21782The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sebastian Sanchez
- Department of Neurology, 21782The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Jacob M Miller
- Department of Neurology, 21782The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sedat Kandemirli
- Department of Radiology, 21782The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Chengcheng Zhu
- Department of Radiology, 7284University of Washington, Seattle, WA, USA
| | - Amir Shaban
- Department of Neurology, 21782The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Enrique C Leira
- Department of Neurology, 21782The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Edgar A Samaniego
- Department of Neurology, 21782The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Department of Neurosurgery, 21782The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Department of Radiology, 21782The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Sakata A, Sakamoto R, Fushimi Y, Nakajima S, Hinoda T, Oshima S, Wetzl J, Schmidt M, Okawa M, Yoshida K, Miyamoto S, Nakamoto Y. Low-dose contrast-enhanced time-resolved angiography with stochastic trajectories with iterative reconstruction (IT-TWIST-MRA) in brain arteriovenous shunt. Eur Radiol 2022; 32:5392-5401. [PMID: 35298680 DOI: 10.1007/s00330-022-08678-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/06/2022] [Accepted: 02/17/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the feasibility of low-dose contrast-enhanced four-dimensional (4D) time-resolved angiography with stochastic trajectories (TWIST) with iterative reconstruction (hereafter IT-TWIST-MRA) covering the whole brain and to compare IT-TWIST-MRA and TWIST-MRA with reference to digital subtraction angiography (DSA) in the evaluation of arteriovenous shunts (AVS). METHODS Institutional Review Board approval was obtained for this observational study, and the requirement for written informed consent was waived. Twenty-nine patients with known AVS underwent TWIST-MRA on a 3-T MRI scanner, using low-dose injection (0.02 mmol/kg) of gadolinium-based contrast agent (GBCA) with each of Fourier and iterative reconstruction between September 2016 and October 2019. Visual evaluation of image quality was conducted for delineation of (a) the normal cerebral arteries and veins and (b) AVS feeder, shunt, and drainer vessels. Region-of-interest evaluation was conducted to evaluate bolus sharpness and baseline signal fluctuation in the signal intensity of the cerebral vessels. We compared the detection of AVS between TWIST-MRA and IT-TWIST-MRA. The paired-samples Wilcoxon test was used to test the differences between TWIST-MRA and IT-TWIST-MRA. RESULTS Visualization scores for normal vasculature and AVS angioarchitecture were significantly better for images produced using IT-TWIST-MRA than those using TWIST-MRA. Peak signal and the enhancement slope of the time-intensity curve were significantly higher for IT-TWIST-MRA than for TWIST-MRA, except for the superior sagittal sinus (SSS). Baseline intensity fluctuation was significantly lower for IT-TWIST-MRA than for TWIST, except for SSS. CONCLUSIONS IT-TWIST-MRA yields clinically feasible 4D MR-DSA images and delineates AVS even with low-dose GBCA. KEY POINTS • Iterative reconstruction significantly improves the image quality of TWIST-MRA covering the whole brain. • The short temporal footprint and denoising effect of iterative reconstruction enhances the quality of 4D-MRA. • IT-TWIST-MRA yields clinically feasible images of AVS with low-dose GBCA.
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Affiliation(s)
- Akihiko Sakata
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Ryo Sakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Satoshi Nakajima
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takuya Hinoda
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Sonoko Oshima
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Jens Wetzl
- Siemens Healthcare GmbH, Allee am Roethelheimpark 2, 91052, Erlangen, Germany
| | - Michaela Schmidt
- Siemens Healthcare GmbH, Allee am Roethelheimpark 2, 91052, Erlangen, Germany
| | - Masakazu Okawa
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
| | - Kazumichi Yoshida
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Development and validation of visual grading system for stenosis in intracranial atherosclerotic disease on time-of-flight magnetic resonance angiography. Eur Radiol 2021; 32:2781-2790. [PMID: 34839372 DOI: 10.1007/s00330-021-08319-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Although the overestimation problem of time-of-flight magnetic resonance angiography (TOF-MRA) applying the warfarin-aspirin symptomatic intracranial disease (WASID) method to assess intracranial arterial stenosis has often been suggested, no pertinent grading system for TOF-MRA has been developed. We aimed to develop and evaluate the performance of a visual grading system for intracranial arterial stenosis on TOF-MRA (MRAVICAST). METHODS This single-center cohort study analyzed prospective observational registry data from a comprehensive stroke center between January 2014 and February 2020. Patients with confirmed stenosis of the intracranial large arteries who underwent confirmative digital subtraction angiography (DSA) were included; a 4-point grading system was developed based on physical characteristics of TOF-MRA. The overall diagnostic accuracies of MRAVICAST for each grade, interobserver reproducibility, and positive predictive values for > 50% and > 70% stenoses were evaluated. RESULTS We analyzed 132 segments with intracranial atherosclerotic stenosis from 71 patients (34 men and 37 women; mean age, 61.0 ± 15.25 years; range, 21-89 years). The overall diagnostic accuracy of MRAVICAST (93.9%, 124/132) was higher than that of MRAWASID (50.8%, 67/132) for each grade. The degree of stenosis did not differ significantly between MRAVICAST and DSAWASID (p = .849). Regarding reproducibility, MRAVICAST demonstrated excellent interobserver agreement (ICC, 0.989; 95% CI, 0.979-0.999). The positive predictive values of MRAVICAST for the diagnosis of > 50% and > 70% stenoses were 97.3% and 100.0%, respectively. CONCLUSIONS The new intuitive grading system accurately and reliably determined the degree of stenosis in intracranial arterial atherosclerosis patients. MRAVICAST could be a versatile alternative to MRAWASID for evaluating intracranial arterial stenosis. KEY POINTS • In this retrospective diagnostic study (sample: 132 stenotic segments), the overall accuracy of the visual grading system (MRAVICAST) was 94%, and positive predictive value for > 50% stenosis was 97%. • In the era of medical treatment for intracranial atherosclerotic stenosis, MRAVICAST could be a versatile alternative method to MRAWASID for evaluating intracranial arterial stenosis.
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