1
|
Sanchez S, Gudino-Vega A, Guijarro-Falcon K, Miller JM, Noboa LE, Samaniego EA. MR Imaging of the Cerebral Aneurysmal Wall for Assessment of Rupture Risk. Neuroimaging Clin N Am 2024; 34:225-240. [PMID: 38604707 DOI: 10.1016/j.nic.2024.01.003] [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] [Indexed: 04/13/2024]
Abstract
The evaluation of unruptured intracranial aneurysms requires a comprehensive and multifaceted approach. The comprehensive analysis of aneurysm wall enhancement through high-resolution MRI, in tandem with advanced processing techniques like finite element analysis, quantitative susceptibility mapping, and computational fluid dynamics, has begun to unveil insights into the intricate biology of aneurysms. This enhanced understanding of the etiology, progression, and eventual rupture of aneurysms holds the potential to be used as a tool to triage patients to intervention versus observation. Emerging tools such as radiomics and machine learning are poised to contribute significantly to this evolving landscape of diagnostic refinement.
Collapse
Affiliation(s)
- Sebastian Sanchez
- Department of Neurology, Yale University, LLCI 912, New Haven, CT 06520, USA
| | - Andres Gudino-Vega
- Department of Neurology, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | | | - Jacob M Miller
- Department of Neurology, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Luis E Noboa
- Universidad San Francisco de Quito, Quito, Ecuador
| | - Edgar A Samaniego
- Department of Neurology, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; Department of Neurosurgery, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; Department of Radiology, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| |
Collapse
|
2
|
Sanchez S, Saenz-Hinojosa S, Samaniego EA. In reply to the letter to the editor regarding: Cerebral arteriopathy in a pediatric stroke due to mutations in MYH11. J Stroke Cerebrovasc Dis 2023; 32:107349. [PMID: 37805335 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/09/2023] Open
|
3
|
Huang L, Wu X, Liu Y, Guo X, Ye J, Cai W, Wang S, Luo B. Qualitative and quantitative plaque enhancement on high-resolution vessel wall imaging predicts symptomatic intracranial atherosclerotic stenosis. Brain Behav 2023; 13:e3032. [PMID: 37128149 PMCID: PMC10275550 DOI: 10.1002/brb3.3032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 03/28/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND AND PURPOSE Intracranial atherosclerotic stenosis (ICAS) is a major cause of ischemic stroke (IS), and high-resolution vessel wall imaging (HR-VWI) can be used to assess the plaque characteristics of ICAS. This study aimed to qualitatively and quantitatively assess plaque enhancement of ICAS and to investigate the relationship between plaque enhancement, plaque morphological features, and IS. METHODS Data from adult patients with ICAS from April 2018 to July 2022 were retrospectively collected, and all patients underwent HR-VWI examination. Plaque enhancement was qualitatively and quantitatively assessed, and the plaque-to-pituitary stalk contrast ratio (CR) indicated the degree of plaque enhancement. Plaque characteristics, such as plaque burden and area, were quantitatively measured using HR-VWI. Furthermore, receiver-operating characteristic (ROC) analysis was performed to assess the ability of CR to discriminate plaque enhancement. The patients were divided into a symptomatic ICAS group and an asymptomatic ICAS group according to the clinical and imaging characteristics. Univariate and multivariate analyses were performed to investigate which factors were significantly associated with plaque enhancement and symptomatic ICAS. The plaque burden and CR were compared using linear regression. RESULTS A total of 91 patients with ICAS were enrolled in this study. ICAS plaque burden was significantly associated with plaque enhancement (p = .037), and plaque burden was linearly positively correlated with CR (R = 0.357, p = .001). ROC analysis showed that the cutoff value of CR for plaque enhancement was 0.56 (specificity of 81.8%). Both plaque enhancement and plaque burden were significantly associated with symptomatic ICAS, and only plaque enhancement was an independent risk factor after multivariate analysis. CONCLUSION Plaque burden was an independent risk factor for plaque enhancement and showed a linear positive correlation with CR. The cutoff value of CR for plaque enhancement was 0.56, and CR ≥ 0.56 was significantly associated with symptomatic ICAS, which was independently associated with plaque enhancement.
Collapse
Affiliation(s)
- Li‐Xin Huang
- Department of Neurosurgery, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
- Department of Neurosurgery, The Eighth Affiliated HospitalSun Yat‐Sen UniversityShenzhenChina
| | - Xiao‐Bing Wu
- Department of Neurosurgery, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Yi‐Ao Liu
- Department of Neurosurgery, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
- Department of Neurosurgery, The Eighth Affiliated HospitalSun Yat‐Sen UniversityShenzhenChina
| | - Xin Guo
- Department of Neurosurgery, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
- Department of Neurosurgery, The Eighth Affiliated HospitalSun Yat‐Sen UniversityShenzhenChina
| | - Jie‐Shun Ye
- School of Civil Engineering and TransportationSouth China University of TechnologyGuangzhouChina
| | - Wang‐Qing Cai
- Department of Neurosurgery, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Sheng‐Wen Wang
- Department of Neurosurgery, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Bin‐ Luo
- Department of Neurosurgery, The Eighth Affiliated HospitalSun Yat‐Sen UniversityShenzhenChina
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|