Abstract 108: Additional Value of Intracranial Vessel Wall Imaging to Determine the Etiology of Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Joanna D Schaafsma ◽  
David J Mikulis ◽  
Jonathan Coutinho ◽  
Cheryl S Jaigobin ◽  
Daniel M Mandell
Keyword(s):  
Differential Diagnosis ◽  
Ischemic Stroke ◽  
Vessel Wall ◽  
Stroke Work ◽  
Standard Work ◽  
Additional Information ◽  
Stroke Etiology ◽  
Additional Value ◽  
Work Up ◽  
Wall Imaging

Objective: High-resolution MR-imaging of the intracranial arterial wall is a promising technique for diagnosis of intracranial arteriopathies in patients with ischemic stroke. We aimed to evaluate the additional value of vessel wall imaging (VWI) to the standard work-up of ischemic stroke patients. Methods: We selected all patients with ischemic stroke who had intracranial VWI at our institute to evaluate possible intracranial arteriopathy, such as atherosclerosis, dissection, vasculitis, or reversible cerebral vasoconstriction syndrome. Two observers, who were blinded to the VWI, first determined the most likely stroke etiology based on the standard work-up (clinical history, brain parenchyma imaging, vessel lumen imaging, laboratory results, and cardiac work-up). Then VWI was reviewed to assess whether this would change the suspected stroke etiology or whether the differential diagnosis could be narrowed down. Results: Between 2006 and 2014, 199 patients with ischemic stroke, mean age 55 (IQ-range: 44-67) had VWI. VWI provided additional information to the standard stroke work-up in 128 patients (64%). In 38/199 patients (19%) the conclusion on stroke etiology was altered based on VWI and in 90/199 patients (45%) the differential diagnosis was further narrowed after VWI. VWI did not have additional value when the most likely stroke etiology based on the standard work-up remained the same (50/199 patients; 25%), when the differential diagnosis could not be narrowed down (16/199; 8%), or in case of poor image quality (5/199 patients; 3%). Patients under the age of 46 benefited more often from VWI than older adults (Odds Ratio 3.5; 95%CI: 1.7-7.6). Conclusion: VWI provided additional information to the conventional stroke work-up in almost two-thirds of patients suspected to have intracranial arteriopathy. Next step is to determine how frequently this additional information resulted in altered therapy.

Abstract WMP43: Bright Signals of MCA Plaque on T2 Weighted Vessel Wall Imaging are Associated With Ischemic Stroke

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Yannan Yu ◽  
Mengwei Liu ◽  
Mingli Li ◽  
Yuyuan Xu ◽  
Shan Gao ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Vessel Wall ◽  
Vessel Wall Imaging ◽  
Wall Imaging

scholarly journals MRI Vessel Wall Imaging after Intra-Arterial Treatment for Acute Ischemic Stroke

2020 ◽  
Vol 41 (4) ◽  
pp. 624-631
Author(s):  
A. Lindenholz ◽  
I.C. van der Schaaf ◽  
A.G. van der Kolk ◽  
H.B. van der Worp ◽  
A.A. Harteveld ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Vessel Wall ◽  
Vessel Wall Imaging ◽  
Wall Imaging

Abstract WMP48: 3D MR Vessel Wall Imaging Reveals Plaque-Specific Responses to Medical Therapy in Patients With Symptomatic Intracranial Atherosclerotic Disease: Initial Experience

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jiayu Xiao ◽  
Huijuan Miao ◽  
Song Shlee ◽  
Konrad Schlick ◽  
Tao Jiang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Medical Therapy ◽  
Wall Thickness ◽  
Vessel Wall ◽  
Plaque Volume ◽  
Post Contrast ◽  
Intracranial Atherosclerotic Disease ◽  
Maximum Wall Thickness ◽  
Wall Imaging

Introduction: Intracranial atherosclerotic disease (ICAD) is a common cause of ischemic stroke worldwide and carries a high rate of recurrence. Follow-up of symptomatic ICAD routinely relies on assessment of lumen stenosis. Magnetic resonance vessel wall imaging (MR-VWI) has recently demonstrated the potential to reliably quantify plaque features. This work presents our experience in using serial MR-VWI to quantify the morphological changes of culprit lesions in response to medical therapy in patients with symptomatic ICAD. Methods: Twenty-four patients (4 females; age 46.75±14.05 years) with acute ischemic stroke secondary to ICAD underwent baseline (1-44 days after onset) and follow-up (3-15 months after baseline) 3D whole-brain MR-VWI, which was used to acquire pre- and post-contrast images. Quantitative plaque features, including plaque volume, peak normalized wall index (pNWI), maximum wall thickness, stenosis degree, pre-contrast plaque-wall contrast ratio (CR), and post-contrast plaque enhancement ratio (ER), were derived from both baseline and follow-up MR-VWI scans. Patients with 18-month clinical follow-up were divided into progression and non-progression groups depending on whether major vascular events (stroke, TIA, death) occurred. Results: Seventeen patients were categorized into the non-progression group and 4 into the progression group. Maximum wall thickness (P=0.047), CR (P=0.020) and ER (P=0.012) showed significant decreases in the non-progression group. In the progression group, all 4 patients showed an increase in pNWI, stenosis degree and CR; plaque volume, maximum wall thickness and ER increased in three patients. Typical cases are shown in Figure. Conclusions: Quantitative assessment of lesion-specific responses to medical therapy is clinically feasible with serial MR-VWI. The changes of plaque over time may be useful for ischemic stroke risk stratification with implications for ICAD medical management.

scholarly journals A proposed method for outlining occluded intracranial artery using 3D T2-weighted sampling perfection with application optimized contrasts using different flip angle evolution (SPACE)

2021 ◽  
Vol 10 (3) ◽  
pp. 205846012110032
Author(s):  
Saya Ozaki ◽  
Shigetaka Okamoto ◽  
Naoki Shinohara
Keyword(s):  
Ischemic Stroke ◽  
Vessel Wall ◽  
Mechanical Thrombectomy ◽  
Imaging Techniques ◽  
Artery Occlusion ◽  
Flip Angle ◽  
Intracranial Artery ◽  
Artery Disease ◽  
Intracranial Artery Disease ◽  
Wall Imaging

High-resolution vessel wall imaging techniques have been developed for clinical use in various types of intracranial artery disease. Numerous studies have described techniques for evaluating remodeling patterns and plaque character, but few have reported a method for outlining obstructed vessels in intracranial artery occlusion. The course of the vessel affects the success of recanalization and can cause complications in mechanical thrombectomy for acute ischemic stroke. We propose imaging with 3D T2-weighted sampling perfection with application optimized contrasts using different flip angle evolution (SPACE) as a useful tool for describing the course of an occluded artery in ischemic stroke due to intracranial artery occlusion.

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

Neurology ◽  
2018 ◽  
Vol 91 (19) ◽  
pp. e1760-e1769 ◽  
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.

scholarly journals Magnetic resonance imaging in the diagnosis of the outcomes of brachiocephalic artery dissection

2021 ◽  
Vol 12 (2) ◽  
pp. 92-97
Author(s):  
T. A. Lesnykh ◽  
M. V. Dreval’ ◽  
M. S. Danilova ◽  
M. A. Kravchenko ◽  
L. А. Kalashnikova ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Vessel Wall ◽  
Artery Dissection ◽  
Brachiocephalic Artery ◽  
Resonance Imaging ◽  
Double Lumen ◽  
Aneurysmal Dilation ◽  
Before And After ◽  
Wall Imaging

Introduction. Vessel wall imaging in patients with dissection plays an impotent role in the differential diagnosis of stenoocclusive processes of the main arteries of the head. However, the interpretation of changes in long-term periods remains difficulties. Purpose: to determine and compare the imaging patterns of the consequences of the postponed dissection using MRI and ultrasound.Materials and methods. 30 patients with confirmed dissection were examined for more than 1 year from the date of diagnosis. MRI was performed using vessel wall protocol imaging before and after contrast enhancement.Results. Postpone dissection imaging patterns were revealed: aneurysmal dilation of the artery (27%) and double lumen (20%) at the site of dissection; prolonged stenosis in 10% of cases, intimal flap — in 3% of cases. Occlusion persisted in 40% of cases.Conclusion. The use of MRI can improve the differential diagnosis of the causes of the stenоocclusive process of the main arteries of the head.

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