Intracranial atherosclerosis: Review of imaging features and advances in diagnostics

2022 ◽  
pp. 174749302110664
Author(s):  
Song J Kim ◽  
David J Schneider ◽  
Edward Feldmann ◽  
David S Liebeskind
Keyword(s):  
Fluid Dynamics ◽  
Computed Tomography ◽  
Atherosclerotic Disease ◽  
Imaging Features ◽  
Secondary Stroke Prevention ◽  
Intracranial Atherosclerosis ◽  
Prevention Strategies ◽  
Moderate Risk ◽  
True Prevalence ◽  
Intracranial Atherosclerotic Disease

Intracranial atherosclerotic disease is one of the leading causes of ischemic strokes and poses a moderate risk of recurrence. Diagnosis is currently limited to stenosis on luminal imaging, which likely underestimates the true prevalence of the disease. Detection of non-stenosing intracranial atherosclerosis is important in order to optimize secondary stroke prevention strategies. This review collates findings from the early seminal trials and the latest studies in advanced radiological techniques that characterize symptomatic intracranial atherosclerotic disease across various imaging modalities. While computed tomography angiography (CTA) and magnetic resonance angiography (MRA) comprise diagnostic mainstays in identifying stenotic changes secondary to atherosclerosis, emerging techniques such as high-resolution MRA, quantitative MRA, and computational fluid dynamics may reveal a myriad of other underlying pathophysiological mechanisms.

Current Concepts in the Management of Intracranial Atherosclerotic Disease

Neurosurgery ◽  
2006 ◽  
Vol 59 (suppl_5) ◽  
pp. S210-S218 ◽  
Author(s):  
Robert D. Ecker ◽  
Elad I. Levy ◽  
Eric Sauvageau ◽  
Ricardo A. Hanel ◽  
L Nelson Hopkins
Keyword(s):  
Endovascular Treatment ◽  
Poor Prognosis ◽  
Intracranial Stenosis ◽  
Atherosclerotic Disease ◽  
Intracranial Atherosclerosis ◽  
Intracranial Atherosclerotic Disease ◽  
New Models ◽  
Disease Study ◽  
Angioplasty And Stenting ◽  
Neuroimaging Techniques

Abstract MEDICALLY REFRACTORY, SYMPTOMATIC intracranial atherosclerotic disease has a poor prognosis. Based on the results of the Warfarin-Aspirin Symptomatic Intracranial Disease study, the risk of ipsilateral stroke at 1.8 years is between 13 and 14% in patients with symptomatic intracranial atherosclerosis. Synergistic advances in intracranial angioplasty and stenting, modern neuroimaging techniques, and periprocedural and postprocedural antithrombotic regimens are creating new models for the diagnosis and successful endovascular treatment of intracranial stenosis. In this article, the most recent clinical developments and concepts for the diagnosis and endovascular treatment of intracranial atherosclerotic disease are discussed.

Endovascular Advances for Intracranial Occlusive Disease

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S126-S132 ◽  
Author(s):  
Mandy J. Binning ◽  
Erol Veznedaroglu
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Stent Placement ◽  
The United States ◽  
Atherosclerotic Disease ◽  
High Grade ◽  
Intracranial Atherosclerosis ◽  
Intracranial Atherosclerotic Disease ◽  
Surgical Bypass ◽  
Angioplasty And Stenting

Abstract Stroke is the fourth leading cause of death in the United States. Intracranial atherosclerotic disease accounts for 8%-10% of ischemic stroke in the United States. So far, surgical bypass has not proved to be superior to medical therapy. As both medical and endovascular therapies for intracranial atherosclerosis evolve, so too do the guidelines for treatment. Initial reports on the results of stent placement for symptomatic high-grade intracranial atherosclerotic disease were encouraging; however, recent trials suggest that initial medical management may be preferable. Currently, intracranial angioplasty and stenting for symptomatic intracranial atherosclerosis is now more controversial. Further trials are necessary to help determine which patients are ideal for endovascular therapies.

Abstract WP271: The Role of Ring Finger Protein213 Variant in Patients With Intracranial Atherosclerotic Disease

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Hyung Jun Kim ◽  
Oh Young Bang ◽  
In-Young Baek ◽  
Jae-Hwan Kim ◽  
Ye Sel Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Moyamoya Disease ◽  
Ring Finger ◽  
Vascular Risk Factors ◽  
Imaging Features ◽  
Intracranial Atherosclerosis ◽  
Vascular Risk ◽  
Intracranial Atherosclerotic Disease ◽  
Tandem Lesions

Introduction: The Ring Finger Protein213 ( RNF213 ) gene variant is a relatively common variant in general population of East Asian countries (0.43 to 1.8%). Recently, RNF213 is reportedly a susceptibility gene not only for moyamoya disease (MMD) but also for intracranial atherosclerosis (ICAS) in this population. However, the role of this genetic factor in patients with ICAS is unknown. We hypothesized that this variant is involved in the pathogenesis of ICAS. Methods: We conducted a prospective study of patients with ICAS and MMD using high-resolution MRI (HR-MRI) and RNF213 (p.Arg4810Lys variant) gene studies. Patients were classified into intracranial atherosclerosis (ICAS) when relevant plaques existed on HR-MRI and moyamoya disease (MMD) when patients had RNF213 variant and HR-MRI showed no plaque but characteristic features of MMD (negative remodeling and basal collaterals). We compared clinical and neuroimaging features between (a) the RNF213 - ICAS, (b) the RNF213 + ICAS, and (c) MMD group. Results: Among 178 patients analyzed, 79 were the RNF213 - ICAS, 37 the RNF213 variant+ ICAS, and 62 the MMD group. Vascular risk factors were more frequently observed in ICAS than MMD patients, but there was no difference between RNF213 - ICAS and the RNF213 variant+ ICAS. Moreover, the site of occlusive disease was different between ICAS and MMD patients, but not between RNF213 - ICAS and the RNF213 variant+ ICAS. It was more distally located in RNF213 variant+ ICAS than in MMD (p=0.012). Compared to RNF213 - ICAS patients, tandem lesions were significantly more common in RNF213 + ICAS (24.1% vs. 67.6%, p<0.05), after adjusted for vascular risk factors. Conclusions: Patients with ICAS and the RNF213 variant showed distinct clinical and imaging features from MMD patients. A high frequency of tandem lesions in RNF213 + ICAS suggest that this variant may have synergic effects in atherosclerosis which should be tested in a larger cohort.

Abstract P314: Mechanisms of Intracranial Atherosclerotic Disease Drive Hypoperfusion Patterns

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Song J Kim ◽  
Shadi Yaghi ◽  
Tristan Honda ◽  
Fabien Scalzo ◽  
Jason D Hinman ◽  
...  
Keyword(s):  
Diffusion Weighted Imaging ◽  
Underlying Mechanism ◽  
Atherosclerotic Disease ◽  
Intracranial Atherosclerosis ◽  
Mr Perfusion ◽  
Mri Imaging ◽  
Intracranial Atherosclerotic Disease ◽  
Recurrent Strokes ◽  
Core Volume ◽  
Volume Difference

Background: In patients with symptomatic intracranial atherosclerotic disease (ICAD), borderzone infarct pattern and perfusion mismatch have each been shown to independently predict recurrent strokes, which may reflect the shared underlying mechanism of hypoperfusion distal to the intracranial atherosclerosis. As such, we hypothesized that perfusion volumes and patterns may correlate with various ICAD subtypes. Methods: A retrospective, 5-year analysis of consecutive ICAD patients with perfusion imaging for acute strokes (0-24 hours) due to sub-occlusive (50-99%) stenosis was conducted. The following subtypes were assigned based on the infarct pattern seen on the diffusion-weighted imaging (DWI): perforator, borderzone, and thromboembolic. Core volume on MRI and perfusion parameters on CT or MR perfusion, obtained concurrently or within 12 hours of MR DWI, were studied in each group. Results: 42 patients (57% women, mean age 71±13 years old) with acute strokes received MRI imaging upon initial presentation. 15 were found with borderzone, 12 perforator, and 15 with thromboembolic pattern on DWI. Across all ICAD subtypes, median core volume (ADC <620) was 0 mL (0[0-6], 0[0-3], 0[0-7], p =0.95). Hypoperfusion with Tmax >4s and Tmax >6s delay volumes was significantly higher in the thromboembolic and borderzone infarct patterns compared to the perforator subtype ( Figure 1 ). The volume difference between Tmax >4s and Tmax >6s (Δ Tmax>4s - Tmax>6s) was higher in the borderzone subtype compared to thromboembolism when analyzed pairwise. Conclusion: Core volume in ischemic strokes secondary to symptomatic ICAD is minimal. TMax>4 and TMax>6 parameters vary across the different ICAD patterns, with significantly large Tmax>4 delay volumes in the borderzone profile. Perfusion mapping may further elucidate hemodynamic mechanisms underlying ICAD.

scholarly journals Imaging diagnosis of classical and new pneumoconiosis: predominant reticular HRCT pattern

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Akira Masanori
Keyword(s):  
Computed Tomography ◽  
Interstitial Lung Disease ◽  
Imaging Features ◽  
Imaging Findings ◽  
Imaging Diagnosis ◽  
High Resolution Computed Tomography ◽  
Pleural Fibrosis ◽  
Pathologic Findings ◽  
Characteristic Imaging ◽  
The Individual

AbstractOur understanding of the manifestations of pneumoconioses is evolving in recent years. Associations between novel exposures and diffuse interstitial lung disease have been newly recognized. In advanced asbestosis, two types of fibrosis are seen, probably related to dose of exposure, existence of pleural fibrosis, and the host factor status of the individual. In pneumoconiosis of predominant reticular type, nodular opacities are often seen in the early phase. The nodular pattern is centrilobular, although some in metal lung show perilymphatic distribution, mimicking sarcoidosis. High-resolution computed tomography enables a more comprehensive correlation between the pathologic findings and clinically relevant imaging findings. The clinician must understand the spectrum of characteristic imaging features related to both known dust exposures and to historically recent new dust exposures.

scholarly journals Chest computed tomography imaging features in patients with coronavirus disease 2019 (COVID-19)

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110106
Author(s):  
Hoda Salah Darwish ◽  
Mohamed Yasser Habash ◽  
Waleed Yasser Habash
Keyword(s):  
Computed Tomography ◽  
Intermediate Phase ◽  
Early Stage ◽  
Lower Lobe ◽  
Ground Glass Opacity ◽  
Intermediate Stage ◽  
Mediastinal Lymphadenopathy ◽  
Imaging Features ◽  
Stage Disease ◽  
Bilateral Lesions

Objective To analyze computed tomography (CT) features of symptomatic patients with coronavirus disease 2019 (COVID-19). Methods Ninety-five symptomatic patients with COVID-19 confirmed by reverse-transcription polymerase chain reaction from 1 May to 14 July 2020 were retrospectively enrolled. Follow-up CT findings and their distributions were analyzed and compared from symptom onset to late-stage disease. Results Among all patients, 15.8% had unilateral lung disease and 84.2% had bilateral disease with slight right lower lobe predilection (47.4%). Regarding lesion density, 49.4% of patients had pure ground glass opacity (GGO) and 50.5% had GGO with consolidation. Typical early-stage patterns were bilateral lesions in 73.6% of patients, diffuse lesions (41.0%), and GGO (65.2%). Pleural effusion occurred in 13.6% and mediastinal lymphadenopathy in 11.5%. During intermediate-stage disease, 47.4% of patients showed GGO as the disease progressed; however, consolidation was the predominant finding (52.6%). Conclusion COVID-19 pneumonia manifested on lung CT scans with bilateral, peripheral, and right lower lobe predominance and was characterized by diffuse bilateral GGO progressing to or coexisting with consolidation within 1 to 3 weeks. The most frequent CT lesion in the early, intermediate, and late phases was GGO. Consolidation appeared in the intermediate phase and gradually increased, ending with reticular and lung fibrosis-like patterns.

scholarly journals Agreement between rhinomanometry and computed tomography-based computational fluid dynamics

2021 ◽  
Author(s):  
Manuel Berger ◽  
Aris I. Giotakis ◽  
Martin Pillei ◽  
Andreas Mehrle ◽  
Michael Kraxner ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Computed Tomography ◽  
Computational Fluid Dynamics ◽  
Lattice Boltzmann ◽  
Univariate Analysis ◽  
Error Rates ◽  
Bland Altman Method ◽  
Nasal Side ◽  
Computational Fluid Dynamics Cfd ◽  
Side Error

Abstract Purpose Active anterior rhinomanometry (AAR) and computed tomography (CT) are standardized methods for the evaluation of nasal obstruction. Recent attempts to correlate AAR with CT-based computational fluid dynamics (CFD) have been controversial. We aimed to investigate this correlation and agreement based on an in-house developed procedure. Methods In a pilot study, we retrospectively examined five subjects scheduled for septoplasty, along with preoperative digital volume tomography and AAR. The simulation was performed with Sailfish CFD, a lattice Boltzmann code. We examined the correlation and agreement of pressure derived from AAR (RhinoPress) and simulation (SimPress) and these of resistance during inspiration by 150 Pa pressure drop derived from AAR (RhinoRes150) and simulation (SimRes150). For investigation of correlation between pressures and between resistances, a univariate analysis of variance and a Pearson’s correlation were performed, respectively. For investigation of agreement, the Bland–Altman method was used. Results The correlation coefficient between RhinoPress and SimPress was r = 0.93 (p < 0.001). RhinoPress was similar to SimPress in the less obstructed nasal side and two times greater than SimPress in the more obstructed nasal side. A moderate correlation was found between RhinoRes150 and SimRes150 (r = 0.65; p = 0.041). Conclusion The simulation of rhinomanometry pressure by CT-based CFD seems more feasible with the lattice Boltzmann code in the less obstructed nasal side. In the more obstructed nasal side, error rates of up to 100% were encountered. Our results imply that the pressure and resistance derived from CT-based CFD and AAR were similar, yet not same.

Intraplaque Hemorrhage in Symptomatic Intracranial Atherosclerotic Disease

2011 ◽  
Vol 21 (2) ◽  
pp. e159-e161 ◽  
Author(s):  
Tanya N. Turan ◽  
Leonardo Bonilha ◽  
Paul S. Morgan ◽  
Robert J. Adams ◽  
Marc I. Chimowitz
Keyword(s):  
Atherosclerotic Disease ◽  
Intraplaque Hemorrhage ◽  
Intracranial Atherosclerotic Disease

scholarly journals Imaging angiogenesis using 68Ga-NOTA-PRGD2 positron emission tomography/computed tomography in patients with severe intracranial atherosclerotic disease

2017 ◽  
Vol 37 (10) ◽  
pp. 3401-3408 ◽  
Author(s):  
Shi Shu ◽  
Li Zhang ◽  
Yi Cheng Zhu ◽  
Fang Li ◽  
Li Ying Cui ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Emission Tomography ◽  
Time Interval ◽  
Arterial Lesion ◽  
Event Time ◽  
Intracranial Atherosclerotic Disease ◽  
Positron Emission ◽  
Recent Group ◽  
The Brain

Angiogenesis is a critical compensation route, which has been demonstrated in the brain following ischemic stroke; however, few studies have investigated angiogenesis in chronic intracranial atherosclerosis disease (ICAD). We used 68Ga-NOTA-PRGD2 positron emission tomography/computed tomography based imaging to detect angiogenesis in chronic ICAD and to explore the factors that may have affected it. A total of 21 participants with unilateral severe chronic ICAD were included in the study. Of the 21 participants, 19 were men; the mean (SD) age was 52 (15) years. In 18 participants, we observed elevated 68Ga-NOTA-PRGD2 uptake in the peri-infarct, subcortical, and periventricular regions of the lesioned side, with a higher 68Ga-NOTA-PRGD2 SUVmax compared to that in the contralateral hemisphere (0.15 vs. 0.06, p=0.001). The 18F-FDG PET SUVmax was significantly lower on the lesioned side (11.28 vs. 13.92, p=0.001). Subgroup analyses revealed that the recent group (<6 months) had a higher lesion-to-contralateral region ratio SUVmax than the remote group (>6 months) (6.73 vs. 2.36, p<0.05). Our results provide molecular imaging evidence of angiogenesis in patients with severe chronic ICAD. Furthermore, the extent of angiogenesis in chronic ICAD may be affected by the post-qualified event time interval, and not by infarction itself or the severity of the arterial lesion.

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