Diagnostic Impact of Intracranial Vessel Wall MRI in 205 Patients with Ischemic Stroke or TIA

Introduction: Inversion-recovery prepared variable-flip-angle 3D FSE (IR-SPACE) was recently proposed as a whole-brain vessel wall MRI method to assess intracranial vessel wall (IVW) abnormalities. Compared with conventional SPACE or 2D FSE, it provides more heavily T1 weighted (T1w) contrast that, based on extensive research on carotid atherosclerosis, is highly sensitive to vulnerable atherosclerotic plaque features - intraplaque hemorrhage and inflammation. It was hypothesized that, using the new approach, the prevalence of HT 1 S plaques is higher in the symptomatic side in patients with recent anterior circulation ischemic stroke. Methods: From Oct 2015 to Aug 2016, 33 patients with ischemic stroke (<14 days) and an intracranial stenosis of > 50% were consecutively recruited. The MRI protocol included regular brain MRI and intracranial MRA followed by pre- and post-contrast IR-SPACE. After excluding those with nonatherosclerosis etiology (5) and uninterpretable images (3), 25 patients were available for image review by two independent blind readers. Plaques defined as eccentric wall thickening with or without luminal stenosis were first identified and were then categorized as either hyper-intense or iso-intense using adjacent normal vessel wall for reference. Results: In 25 patients, 65 plaques were identified, with 40 and 25 at the symptomatic and asymptomatic side, respectively. HT1S was shown in 32 plaques on pre-contrast IR-SPACE and in 23 plaques on post-contrast IR-SPACE on the symptomatic side, with 22 plaques in both scenarios. On the asymptomatic side, the incidence of HT1S was lower (i.e. 7 on pre-contrast, 4 on post-contrast, 1 in both). Conclusion: In the current study, IR-SPACE revealed higher prevalence of HT1S in the symptomatic side. Pre-contrast scans identified more HT1S plaques than post-contrast scans, and almost all (22/23) of these HT1S plaques shown on post-contrast images also demonstrated HT1S feature on pre-contrast images. Further classification of these HT1S plaques according to the likelihood to cause stroke will help elucidate the clinical relevance of the above findings and this analysis is underway.

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Distribution and natural course of intracranial vessel wall lesions in patients with ischemic stroke or TIA at 7.0 tesla MRI

European Radiology ◽

10.1007/s00330-014-3564-4 ◽

2015 ◽

Vol 25 (6) ◽

pp. 1692-1700 ◽

Cited By ~ 15

Author(s):

Anja G. van der Kolk ◽

Jaco J. M. Zwanenburg ◽

Manon Brundel ◽

Geert Jan Biessels ◽

Fredy Visser ◽

...

Keyword(s):

Ischemic Stroke ◽

Vessel Wall ◽

Natural Course ◽

Intracranial Vessel ◽

Wall Lesions

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Intracranial Vessel Wall MRI in a Rabbit Elastase Aneurysm Model

10.1055/s-0039-1679663 ◽

2019 ◽

Author(s):

James Ho ◽

Nakisa Sadeghi ◽

Ilana Galex ◽

Nathan Davis ◽

Sofia Cabello ◽

...

Keyword(s):

Vessel Wall ◽

Intracranial Vessel ◽

Aneurysm Model

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Current uses of intracranial vessel wall imaging for clinical practice: a high-resolution MR technique recently available

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20200044 ◽

2020 ◽

Vol 78 (10) ◽

pp. 642-650

Author(s):

Felipe Torres PACHECO ◽

Luiz Celso Hygino da CRUZ JUNIOR ◽

Igor Gomes PADILHA ◽

Renato Hoffmann NUNES ◽

Antônio Carlos Martins MAIA JUNIOR ◽

...

Keyword(s):

Clinical Practice ◽

Vessel Wall ◽

Vascular Diseases ◽

Vascular Wall ◽

Vessel Wall Imaging ◽

Clinical Settings ◽

Direct Evaluation ◽

Intracranial Vessel ◽

Indirect Evaluation ◽

Wall Imaging

ABSTRACT Intracranial vessel wall imaging plays an increasing role in diagnosing intracranial vascular diseases. With the growing demand and subsequent increased use of this technique in clinical practice, radiologists and neurologists should be aware of the choices in imaging parameters and how they affect image quality, clinical indications, methods of assessment, and limitations in the interpretation of these images. Due to the improvement of the MRI techniques, the possibility of accurate and direct evaluation of the abnormalities in the arterial vascular wall (vessel wall imaging) has evolved, adding substantial data to diagnosis when compared to the indirect evaluation based on conventional flow analyses. Herein, the authors proposed a comprehensive approach of this technique reinforcing appropriated clinical settings to better use intracranial vessel wall imaging.

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Complex wall modeling for hemodynamic simulations of intracranial aneurysms based on histologic images

International Journal of Computer Assisted Radiology and Surgery ◽

10.1007/s11548-021-02334-z ◽

2021 ◽

Vol 16 (4) ◽

pp. 597-607

Author(s):

Annika Niemann ◽

Samuel Voß ◽

Riikka Tulamo ◽

Simon Weigand ◽

Bernhard Preim ◽

...

Keyword(s):

Wall Thickness ◽

Vessel Wall ◽

Intracranial Aneurysms ◽

Geometric Model ◽

Image Data ◽

Outer Wall ◽

3D Models ◽

Patient Specific ◽

Intracranial Vessel ◽

Hemodynamic Simulations

Abstract Purpose For the evaluation and rupture risk assessment of intracranial aneurysms, clinical, morphological and hemodynamic parameters are analyzed. The reliability of intracranial hemodynamic simulations strongly depends on the underlying models. Due to the missing information about the intracranial vessel wall, the patient-specific wall thickness is often neglected as well as the specific physiological and pathological properties of the vessel wall. Methods In this work, we present a model for structural simulations with patient-specific wall thickness including different tissue types based on postmortem histologic image data. Images of histologic 2D slices from intracranial aneurysms were manually segmented in nine tissue classes. After virtual inflation, they were combined into 3D models. This approach yields multiple 3D models of the inner and outer wall and different tissue parts as a prerequisite for subsequent simulations. Result We presented a pipeline to generate 3D models of aneurysms with respect to the different tissue textures occurring in the wall. First experiments show that including the variance of the tissue in the structural simulation affect the simulation result. Especially at the interfaces between neighboring tissue classes, the larger influence of stiffer components on the stability equilibrium became obvious. Conclusion The presented approach enables the creation of a geometric model with differentiated wall tissue. This information can be used for different applications, like hemodynamic simulations, to increase the modeling accuracy.

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

Stroke ◽

10.1161/str.48.suppl_1.181 ◽

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.

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Abstract WMP55: Vessel Wall Characteristics using High Resolution Magnetic Resonance Imaging in Reversible Cerebral Vasoconstriction Syndrome and Central Nervous System Vasculitis

Stroke ◽

10.1161/str.44.suppl_1.awmp55 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Russell Cerejo ◽

Seby John ◽

Tariq Hammad ◽

Emmanuel C. Obusez ◽

Rula Hajj-ali ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Central Nervous System ◽

Vessel Wall ◽

Clinical Presentation ◽

Wall Thickening ◽

Resonance Imaging ◽

Cns Vasculitis ◽

Cerebral Vasoconstriction ◽

Intracranial Vessel ◽

Vessel Stenosis

Introduction: Reversible cerebral vasoconstriction syndrome (RCVS) and central nervous system (CNS) vasculitis often have similar initial clinical presentation, laboratory findings and imaging features creating a diagnostic dilemma. High-resolution-3-Tesla Magnetic Resonance Imaging with Gadolinium contrast (HR-MRI) is a non-invasive method to look at intracranial vessel wall characteristics. Methods: A retrospective analysis of all patients with a diagnosis of RCVS or CNS vasculitis that underwent HR-MRI at our institution was performed. Inclusion criteria for RCVS were clinical presentation, no aneurysmal subarachnoid hemorrhage, normal cerebrospinal fluid and reversible multifocal intracranial vessel stenosis whereas criteria for CNS vasculitis were cases with positive brain biopsy or typical clinical presentation, course and laboratory markers with rheumatology and stroke neurology agreement in diagnosis. Demographics, clinical presentation, laboratory testing, imaging studies and outcomes were collected. Results: Eleven patients with RCVS [10 (90.9%) females, mean age 45.2] and 8 with CNS vasculitis [6 primary CNS vasculitis, 6 (75%) males, mean age 43.5] were included in the study. No abnormal vessel wall enhancement or thickening was seen in any of the RCVS patients in areas of vessel stenosis. Six (75%) of CNS vasculitis patients had vessel wall thickening or enhancement (p=0.001 for comparison to RCVS) and the remaining 2 patients had HR-MRI performed 6 and 10 years after diagnosis and chronic treatment. All RCVS patients who had follow up HR-MRI demonstrated resolution of the multifocal stenosis. Two out of 4 CNS vasculitis patients with subsequent HR-MRI imaging had decrease in vessel wall thickening and enhancement after immunosuppressive therapy. Conclusion: In acute stages of presentation, HR-MRI may be useful in differentiating RCVS from CNS vasculitis. It may also be useful in following the disease course to look for resolution of intracranial vessel stenosis in RCVS or treatment response in vasculitis. Further studies are needed to confirm the utility of HR-MRI in diagnosis and disease progression in RCVS and vasculitis.

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