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.

Abstract 205: Longitudinal Study of Intracranial Atherosclerosis Using 3D High Resolution MRI Imaging

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Xuefeng Zhang ◽  
Huan Yang ◽  
Mona Shahriari ◽  
Li Liu ◽  
Yiyi Zhang ◽  
...  
Keyword(s):  
High Resolution ◽  
Wall Thickness ◽  
Vessel Wall ◽  
Time Interval ◽  
Black Blood ◽  
Plaque Progression ◽  
Intracranial Atherosclerotic Disease ◽  
Maximum Wall Thickness ◽  
The Mean

Hypothesis: The progression of asymptomatic intracranial atherosclerotic disease (ICAD) remains relatively unknown. We sought to determine whether the progression of ICAD over 24 months can be quantitatively detected using 3D high-resolution vessel wall MRI. Methods: 28 participants with identified ICAD (14 male; mean age, 80.1±4.94 years, ranges, 71 to 89) were enrolled from Atherosclerosis Risk in Communities Study. The baseline MRI exams were performed on a 3T Siemens scanner that included 3D time-of-flight MRA and 3D black blood MRI (BBMRI) (e.g., acquired resolution: TOF, 0.55 x 0.5 x 0.5 mm 3 ; BBMRI, 0.5 mm 3 ) for identifying atherosclerosis in major intracranial arteries. The follow-up MRI exams were repeated to determine the progression of ICAD. The mean time interval between two scans was 2.65±1.48 years. Three trained readers independently measured the degree of stenosis, plaque thickness, and normalized wall index for both normal wall and identified plaques in both visits. Plaque progression was defined by plaque showing > 2 measurement error of increase in plaque thickness. Reliability was assessed by intraclass correlations (ICC). Results: Inter- and intra-reader reliability for MRI measurements ranged from fair to excellent (ICC, 0.58-0.82). The mean coefficient of variation was 10% for mean wall thickness, 13% for maximum wall thickness and 12% for normalized wall index. Of the 28 participants with ICAD identified at baseline, 18 of 28 participants (64%) had either new plaques or evidence of plaque progression. A total of 152 and 163 plaques were identified at baseline and follow-up, respectively. Among 152 plaques, 45 (30%) progressed, and mean, maximum wall thickness, stenosis and normalized wall index increased 36%, 28%, 27% and 14%, respectively (Table 1). Conclusion: 3D High-resolution vessel wall MRI is reliable tool for measuring changes in ICAD plaque and provides insight into the natural history of ICAD progression in general population.

Disparate trends of atherosclerotic plaque evolution in stroke patients under 18-month follow-up: a 3D whole-brain magnetic resonance vessel wall imaging study

2021 ◽  
pp. 197140092110269
Author(s):  
Jiayu Xiao ◽  
Shlee S Song ◽  
Konrad H Schlick ◽  
Shuang Xia ◽  
Tao Jiang ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Vessel Wall ◽  
Morphological Changes ◽  
Contrast Ratio ◽  
Vessel Wall Imaging ◽  
Atherosclerotic Disease ◽  
Stroke Recurrence ◽  
Intracranial Atherosclerotic Disease ◽  
Maximum Wall Thickness ◽  
Wall Imaging

Purpose The trend of atherosclerotic plaque feature evolution is unclear in stroke patients with and without recurrence. We aimed to use three-dimensional whole-brain magnetic resonance vessel wall imaging to quantify the morphological changes of causative lesions during medical therapy in patients with symptomatic intracranial atherosclerotic disease. Methods Patients with acute ischemic stroke attributed to intracranial atherosclerotic disease were retrospectively enrolled if they underwent both baseline and follow-up magnetic resonance vessel wall imaging. The morphological features of the causative plaque, including plaque volume, peak normalized wall index, maximum wall thickness, degree of stenosis, pre-contrast plaque-wall contrast ratio, and post-contrast plaque enhancement ratio, were quantified and compared between the non-recurrent and recurrent groups (defined as the recurrence of a vascular event within 18 months of stroke). Results Twenty-nine patients were included in the final analysis. No significant differences were found in plaque features in the baseline scan between the non-recurrent ( n = 22) and recurrent groups ( n = 7). The changes in maximum wall thickness (–13.32% vs. 8.93%, P = 0.026), plaque-wall contrast ratio (–0.82% vs. 3.42%, P = 0.005) and plaque enhancement ratio (–11.03% vs. 9.75%, P = 0.019) were significantly different between the non-recurrent and recurrent groups. Univariable logistic regression showed that the increase in plaque-wall contrast ratio (odds ratio 3.22, 95% confidence interval 1.55–9.98, P = 0.003) was related to stroke recurrence. Conclusion Morphological changes of plaque features on magnetic resonance vessel wall imaging demonstrated distinct trends in symptomatic intracranial atherosclerotic disease patients with and without stroke recurrence.

Association of residual stenosis after balloon angioplasty with vessel wall geometries in intracranial atherosclerosis

2021 ◽  
pp. neurintsurg-2021-017997
Author(s):  
Zhikai Hou ◽  
Zhe Zhang ◽  
Long Yan ◽  
Jidong You ◽  
Min Wan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
High Resolution ◽  
Wall Thickness ◽  
Balloon Angioplasty ◽  
Vessel Wall ◽  
Perioperative Complications ◽  
Residual Stenosis ◽  
Wall Area ◽  
Intracranial Atherosclerotic Disease ◽  
Remodeling Index

BackgroundPercutaneous transluminal balloon angioplasty (PTBA) may be an alternative treatment for patients with symptomatic intracranial atherosclerotic disease (ICAD) refractory to medical treatment. This study aimed to investigate the association of vessel wall geometric characteristics on high-resolution magnetic resonance vessel wall imaging (MR-VWI) with low residual stenosis in patients with ICAD after PTBA.MethodsPatients with symptomatic ICAD who underwent PTBA were prospectively and consecutively enrolled. High-resolution MR-VWI was performed before the PTBA. Vessel wall geometries of the target artery, including normalized wall index (NWI: wall area/vessel area × 100%), normalized wall thickness index (NWTI: mean wall thickness/vessel radius × 100%), and remodeling index (RI) were evaluated. Low residual stenosis was defined as postprocedural stenosis degree ≤50%. Perioperative complications including symptomatic ischemic stroke/intracranial hemorrhage, death, and arterial dissection were recorded. The baseline characteristics, vessel wall geometries, and perioperative complications were compared between the patients with low residual stenosis and high residual stenosis.ResultsAmong 60 patients prospectively enrolled, low residual stenosis was achieved in 46 participants (77%). Three patients (5%) suffered from symptomatic ischemic stroke within 30 days. Multivariable logistic regression showed that a lower NWI and lower NWTI were associated with low residual stenosis after PTBA (adjusted OR 0.57, 95% CI 0.35 to 0.94, p=0.027; and adjusted OR 0.88, 95% CI 0.80 to 0.98, p=0.015).ConclusionsLower NWI and NWTI of the target artery on high-resolution MR-VWI were associated with low residual stenosis in patients with ICAD after PTBA.

Abstract 48: High-Resolution Vessel Wall Imaging of Cryptogenic Stroke: A 7T MRI Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jorge A Roa ◽  
Mario Zanaty ◽  
Daizo Ishii ◽  
Colin P Derdeyn ◽  
Girish Bathla ◽  
...  
Keyword(s):  
High Resolution ◽  
Vessel Wall ◽  
Cryptogenic Stroke ◽  
Vessel Wall Imaging ◽  
Observer Agreement ◽  
Intraplaque Hemorrhage ◽  
Post Contrast ◽  
Intracranial Atherosclerotic Disease ◽  
Wall Imaging

Background: High-resolution vessel wall imaging (HR-VWI) has emerged as a useful tool for characterization of intracranial vasculopathic processes. HR-VWI allows better characterization of the arterial wall and may aid in the identification of atherosclerotic plaques, intra-arterial hemorrhages such as in the case of dissections and/or increased contrast enhancement such as in vasculitis. 7T HR-VWI may provide additional information in the identification of stroke mechanism in patients with cryptogenic stroke. Methods: Patients with cryptogenic stroke were prospectively imaged with a 7T scan. Strokes were determined to be cryptogenic after an extensive diagnostic work-up was completed. T1-weighted (pre- and post-contrast), T2-weighted, TOF and SWAN sequences were obtained. Demographic and clinical information was gathered from electronic medical charts. Results: Seventeen patients were included. Mean age was 57.8 ± 16.3 years-old, and 10 (58.8%) were women. HR-VWI determined the etiology of AIS in all subjects: 12 (70.6%) intracranial atherosclerotic disease (ICAD), 3 small-vessel disease and 2 arterial dissections. Inter-observer agreement was κ = 0.92. Plaque enhancement was identified in 14 cases, and intraplaque hemorrhage in 1 case of arterial dissection. In a patient with angiography suggestive of Moyamoya disease, HR-VWI determined the presence of diffuse ICAD as the underlying cause of stroke. Conclusion: HR-VWI may be used in patients with cryptogenic stroke to identify the etiologic mechanism and guide treatment. Figure: Axial-DWI (A) shows an acute right-medullary infarct (arrow). (B) Right-VA stenosis (arrow) on CTA. 7T axial-SWAN (C) reveals focal-susceptibility (arrowhead) and intra-vessel hemosiderin (arrow) suggestive of IPH. Axial-T1 pre-contrast (D), post-contrast (E) and sagittal MPR (F) images show eccentric thickening/enhancement of right-VA (arrowheads), compared to normal-appearing left-VA (arrows D-E).

Abstract 181: Determinants of Intracranial Atherosclerotic Enhancement on Vessel Wall MRI in Patients with Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Adam de Havenon ◽  
Nabeel Chauhan ◽  
Jennifer Majersik ◽  
David Tirschwell ◽  
Ka-Ho Wong ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Vessel Wall ◽  
Recurrent Stroke ◽  
Pulse Sequences ◽  
High Rate ◽  
Stroke Recurrence ◽  
Anterior Circulation ◽  
Post Contrast

Introduction: Enhancing intracranial atherosclerotic plaque on high-resolution vessel wall MRI (vwMRI) is a reliable marker of recent thromboembolism, and confers a recurrent stroke risk of up to 30% a year. Post-contrast plaque enhancement (PPE) on vwMRI is thought to represent inflammation, but studies have not fully examined the clinical, serologic or radiologic factors that contribute to PPE. Methods: Inpatients with acute ischemic stroke due to intracranial atherosclerosis were prospectively enrolled at a single center from 2015-16. vwMRI was performed on a 3T Siemens Verio and included 3D DANTE pulse sequences, pre- and post-contrast (for PPE identification). Three experienced neuroradiologists interpreted vwMRI using a validated multicontrast technique. The Chi-squared, Fisher’s Exact, and Student’s t-test were used for intergroup differences, and logistic regression was fitted to the primary outcome of PPE. Results: Inclusion criteria were met by 35 patients. Atherosclerotic plaques were in the anterior circulation in 21/35 (60%) and PPE was diagnosed in 20/35 (57%) of stroke parent arteries. PPE predictors are shown in Table 1 with logistic regression in Table 2 . Conclusion: PPE is associated with stenosis, which was expected, but the association with HgbA1c is novel. All patients with HgbA1c >8 had PPE and a one point HgbA1c rise increased the odds of PPE 3-fold. Hyperglycemia induces vascular oxidative stress by generating reactive oxygen species, quenching nitric oxide, and triggering an inflammatory cascade. Given the high rate of stroke recurrence in PPE patients, aggressive HgbA1c reduction may be a viable treatment target and warrants additional study.

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

Magnetic resonance vessel wall imaging in intracranial atherosclerotic disease simulating vasculitis

2019 ◽  
Vol 67 (2) ◽  
pp. 588
Author(s):  
PN Sylaja ◽  
K Arun ◽  
Chinmay Nagesh ◽  
C Kesavadas ◽  
SapnaE Sreedharan
Keyword(s):  
Magnetic Resonance ◽  
Vessel Wall ◽  
Vessel Wall Imaging ◽  
Atherosclerotic Disease ◽  
Intracranial Atherosclerotic Disease ◽  
Wall Imaging
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