Eccentric narrowing and enhancement of symptomatic middle cerebral artery stenoses in patients with recent ischemic
Mervyn D I Vergouwen1, Frank L Silver, Daniel M Mandell
1Division of Neurology, Department of Medicine, Toronto Western Hospital, and University of Toronto, 2075 Bayview Ave, Room A442, Toronto, ON M4N 3M5, Canada.
Insights
Atherosclerotic plaques in the middle cerebral artery show enhancement after contrast administration in patients with recent stroke. This enhancement is visible on MRI within months of the stroke event.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Intracranial atherosclerosis is a significant cause of stroke.
- Vessel wall imaging offers insights into plaque characteristics.
Purpose of the Study:
- To characterize middle cerebral artery (MCA) vessel wall imaging findings.
- To determine enhancement patterns in presumed atherosclerotic MCA disease with recent infarction.
Main Methods:
- Case series design at a university hospital.
- Inclusion of patients with atherosclerotic risk factors, MCA stenosis, and recent territorial infarction.
- 3-Tesla contrast-enhanced high-resolution magnetic resonance imaging (MRI).
Main Results:
- Eight patients with MCA stenosis were identified.
- Eccentric plaques were common (M1 and M2 segments).
- Lesion enhancement was observed in all patients scanned within 5 months of stroke; asymptomatic plaques did not enhance.
Conclusions:
- Eccentric plaques in MCA atherosclerosis enhance with contrast.
- Enhancement is detectable via MRI within weeks to months post-stroke.
- Vessel wall imaging can characterize atherosclerotic plaques in the MCA.
Objective:
To characterize the vessel wall imaging findings and enhancement patterns in the middle cerebral artery of patients with presumed atherosclerotic disease and recent infarction in the territory of the affected artery.
Design:
Case series.
Setting:
University hospital.
Patients:
We included patients with (1) 2 or more risk factors for atherosclerotic disease; (2) middle cerebral artery stenosis shown on computed tomography, magnetic resonance, or conventional angiography; and (3) recent infarction in the territory of the affected artery.
Intervention:
3-T contrast-enhanced high-resolution magnetic resonance imaging.
Results:
Eight patients were identified: 6 had an eccentric M1 stenosis, 1 had an eccentric proximal M2 stenosis, and 1 had a distal M2 stenosis with inconclusive eccentricity. Enhancement of the lesion was observed in all patients who underwent scanning within 5 months of the index event. Four intracranial atherosclerotic plaques were found in asymptomatic vessels (1 contralateral middle cerebral artery and 3 other intracranial arteries), and none of these had enhancement.
Conclusion:
Patients with presumed intracranial atherosclerosis of the middle cerebral arteries have eccentric plaques that enhance after the administration of contrast medium when imaging is performed within weeks to months of a cerebral infarct within the arterial territory.
