Spontaneous Middle Cerebral Artery (MCA) dissection and stenosis: Role of vessel wall imaging and 3D-RA endoluminal view as adjunct diagnostic tools in endovascular therapy

Objective: This study investigated the diagnostic performance of MinIP images based on three-dimensional variable-flip-angle turbo spin echo T1 weighted imaging (3D CUBE T1WI) from high-resolution vessel wall magnetic resonance imaging for detecting middle cerebral artery (MCA) stenosis. Methods: A total of 63 consecutive patients were included in this study. MinIP images were reconstructed using 3D CUBE T1WI as the source images. The degree and length of MCA stenosis were measured on MinIP images and were compared with digital subtraction angiography (DSA) as the reference standard. Results: The intra- and interobserver agreement for both the rate and length of MCA stenosis were excellent for the MinIP images. There was also excellent agreement in the degree of MCA stenosis calculated using MinIP images and DSA. MinIP images had a high sensitivity, specificity for diagnosing MCA stenosis. There was a good correlation between the two methods for measuring the rate and length of MCA stenosis. Conclusion: MinIP images based on 3D CUBE T1WI are highly consistent with DSA for evaluating the degree and length of MCA stenosis. Advances in knowledge: MinIP images can be produced as a derivative from vessel wall imaging and implemented as an adjunct to vessel wall imaging without extra acquisition time.

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Abstract WP162: Automatic Detection of Middle Cerebral Artery Plaque on T2-weighted Vessel Wall Imaging

Stroke ◽

10.1161/str.50.suppl_1.wp162 ◽

2019 ◽

Vol 50 (Suppl_1) ◽

Author(s):

Yannan Yu ◽

Irma Ravkic ◽

Wei-Hai Xu ◽

Ming-Li Li ◽

David Liebeskind ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Vessel Wall ◽

Automatic Detection ◽

Vessel Wall Imaging ◽

Wall Imaging

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Middle cerebral artery geometric features are associated with plaque distribution and stroke

Neurology ◽

10.1212/wnl.0000000000006468 ◽

2018 ◽

Vol 91 (19) ◽

pp. e1760-e1769 ◽

Cited By ~ 4

Author(s):

Yan Nan Yu ◽

Ming-Li Li ◽

Yu-Yuan Xu ◽

Yao Meng ◽

Harry Trieu ◽

...

Keyword(s):

Ischemic Stroke ◽

Confidence Interval ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Odds Ratio ◽

Vessel Wall ◽

Vessel Wall Imaging ◽

Geometric Features ◽

Insight Into ◽

Wall Imaging

ObjectiveWe aimed to investigate the geometric features of the middle cerebral artery (MCA) and their relevance to plaque distribution and ischemic stroke.MethodsWe reviewed our institutional vessel wall imaging database. Patients with symptomatic MCA atherosclerosis, asymptomatic MCA atherosclerosis, or without MCA atherosclerosis were included. The MCA geometric features, including M1 segment shape and M1 curve orientation, were defined on magnetic resonance angiography. Plaque distribution and other plaque parameters were identified on vessel wall imaging. The association among MCA geometric features, plaque distribution, and ischemic stroke were analyzed.ResultsA total of 977 MCAs were analyzed (87 atherosclerotic symptomatic MCAs, 459 atherosclerotic asymptomatic MCAs, and 431 plaque-free MCAs). Overall, curved M1 segments were the predominant shape across all groups. In 91.1% of curved atherosclerotic MCAs, the plaque involved the inner wall of the curve. Plaque not involving the inner wall was shorter (p < 0.0001) and thinner (p = 0.005) compared to plaque involving the inner wall. Inferior plaque was observed in 39.9% of inferior-oriented M1 curves compared to 21.7% in non–inferior-oriented M1 curves (p < 0.0001). The absence of an inferior-oriented M1 curve (odds ratio 0.45, 95% confidence interval 0.27–0.77) and presence of superior plaque (odds ratio 2.67, 95% confidence interval 1.52–4.67) were independently associated with stroke after adjusting for plaque length and thickness, degree of stenosis, and remodeling ratio.ConclusionsMCA geometric features are associated with plaque distribution and stroke. Our findings provide insight into the vascular pathophysiology of MCA atherosclerosis.

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Middle Cerebral Artery Atherosclerotic Plaques in Recent Small Subcortical Infarction: A Three-Dimensional High-resolution MR Study

BioMed Research International ◽

10.1155/2015/540217 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 9

Author(s):

Xiao-Dong Zou ◽

Yiu-Cho Chung ◽

Lei Zhang ◽

Ying Han ◽

Qi Yang ◽

...

Keyword(s):

High Resolution ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Vessel Wall ◽

Three Dimensional ◽

Contralateral Side ◽

Vessel Wall Imaging ◽

Atherosclerotic Plaques ◽

Contrast Enhanced ◽

Wall Imaging

Purpose. Conventional two-dimensional vessel wall imaging has been used to depict the middle cerebral artery (MCA) wall in patients with recent small subcortical infarctions (RSSIs). However, its clinical use has been limited by restricted spatial coverage, low signal-to-noise ratio (SNR), and long scan time. We used a novel three-dimensional high-resolution MR imaging (3D HR-MRI) technique to investigate the presence, locations, and contrast-enhanced patterns of MCA plaques and their relationship with RSSI.Methods. Nineteen consecutive patients with RSSI but no luminal stenosis on MR angiography were prospectively enrolled. 3D HR-MRI was performed using a T1w-SPACE sequence at 3.0 T. The presence, locations, and contrast-enhanced patterns of the MCA plaques on the ipsilateral and contralateral sides to the RSSI were analyzed.Results. Eighteen patients successfully completed the study. MCA atherosclerotic plaques occurred more frequently on the ipsilateral than the contralateral side to the RSSI (72.2% versus 33.3%,P=0.044). The occurrence of superiorly located plaques was significantly higher on the ipsilateral than the contralateral side of the MCA (66.7% versus 27.8%;P=0.044).Conclusions. Superiorly located plaques are closely associated with RSSI. 3D high-resolution vessel wall imaging may be a potential tool for etiologic assessment of ischemic stroke.

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Abstract WMP44: Differential Middle Cerebral Artery Plaque Characteristics in Patients With Transient Ischemic Attack and Ischemic Stroke: A High-Resolution MR Vessel Wall Imaging Study

Stroke ◽

10.1161/str.51.suppl_1.wmp44 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Jiayu Xiao ◽

Matthew Padrick ◽

Qi Yang ◽

Tao Jiang ◽

Shuang Xia ◽

...

Keyword(s):

Risk Factor ◽

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Transient Ischemic Attack ◽

Vessel Wall ◽

Vessel Wall Imaging ◽

Plaque Burden ◽

Ischemic Attack ◽

Wall Imaging

Introduction: Intracranial atherosclerotic disease (ICAD) correlates highly with transient ischemic attack (TIA) and acute ischemic stroke (AIS). Magnetic Resonance (MR) vessel wall imaging (VWI) is an emerging non-invasive imaging modality for directly assessing ICAD lesions. Methods: We retrospectively analyzed MR-VWI from 42 TIA patients and 45 AIS patients with ICAD. All patients fulfilled the following criteria: (1) stenosis >30% of a middle cerebral artery (MCA), (2) symptoms contralateral to stenotic MCA, (3) no coexisting stenosis at other major vessels; (4) lack of compelling evidence to other etiologies of stroke/TIA. Vascular lesions were analyzed with MR-VWI with respect to the stenosis degree, vessel wall irregularity, plaque burden (PB), remodeling index (RI), plaque-wall contrast ratio (CR) and plaque enhancement grade (EG). Results: EG (OR 3.88, 95%CI 1.42-10.57, P=0.006) was a risk factor for AIS while PB (OR 0.65, 95%CI 0.27-1.54, P=0.008) was a risk factor for TIA. In patients with 30-70% degree stenosis, CR (OR 5.38, 95%CI 1.39-20.75, P=0.008) was a risk factor for stroke, while PB (OR 0.4, 95%CI 0.1-1.65, P=0.006) remained a risk factor for TIA. Conclusions: In our study, PB appeared as a risk factor for TIA but not for AIS. This suggests that unstable plaque accounting for AIS may have a wide range of PB. We further found that CR and EG are more associated with AIS than TIA. Lesions with high CR and strong enhancement may be more prone to producing the permanent ischemic injury. Further study is needed to elucidate the role of MR-VWI in differential diagnosis and management of TIA and AIS.

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