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Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
The advantage of high-resolution MRI in evaluating basilar plaques: a comparison study with MRA
Young Seo Kim1, Sung-Hwan Lim, Ki-Wook Oh
1Department of Neurology, College of Medicine, Hanyang University, 17 Haengdang-dong, Seongdong-gu, Seoul 133-792, Republic of Korea.
Objective:
Intracranial atherosclerosis (ICAS) is a major cause of ischemic stroke; however it is rather neglected. Vessel wall visualization by high resolution magnetic resonance imaging (HRMRI) might provide more accurate information.
Methods:
A total of 219 consecutive patients with acute ischemic stroke underwent MRI, MRA and proton-density weighted HRMRI. Using HRMRI, the patients were divided into 3 groups with respect to basilar plaques: no plaque (n = 85), minimal plaque (n = 72) and apparent plaque (n = 62). Demographics and characteristics were compared between the groups, and the extents of stenoses calculated from MRA versus HRMRI data were also compared. Factors potentially associated with basilar plaque were validated by multivariate analysis.
Results:
Patients with apparent plaque had higher frequencies of diabetes mellitus, lower high-density lipoprotein and higher hemoglobin A1c, erythrocyte sedimentation rate and homocysteine. Of the 62 cases of apparent plaque, severe stenosis (>50%) was observed in 10 (16%) by MRA and in 27 (43%) by HRMRI, which points to overestimation of plaques by HRMRI. In addition, no stenosis was evident on MRA in 13 patients with apparent plaque even though they had up to 72% stenosis on HRMRI. After adjusting for covariates, basilar artery apparent plaque was independently associated with old age, previous stroke, diabetes mellitus, low HDL and high levels of homocysteine.
Conclusions:
Basilar artery stenosis with plaque is more accurately detected using HRMRI than MRA. In addition, the associated risk factors differ somewhat. The use of HRMRI for evaluating ICAS deserves more attention.
Insights
High-resolution MRI (HRMRI) offers a more accurate assessment of intracranial atherosclerosis (ICAS) and basilar artery stenosis compared to MRA. This advanced imaging technique reveals plaque presence and severity more effectively, aiding stroke risk evaluation.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Science
Background:
- Intracranial atherosclerosis (ICAS) is a significant, yet often overlooked, cause of ischemic stroke.
- Accurate vessel wall visualization is crucial for understanding ICAS and its impact on stroke risk.
Purpose of the Study:
- To compare the efficacy of high-resolution magnetic resonance imaging (HRMRI) versus magnetic resonance angiography (MRA) in detecting basilar artery plaques in stroke patients.
- To identify demographic and clinical factors associated with basilar artery plaque presence.
Main Methods:
- 219 acute ischemic stroke patients underwent MRI, MRA, and proton-density weighted HRMRI.
- Patients were categorized based on basilar artery plaque presence (none, minimal, apparent) using HRMRI.
- Demographics, clinical characteristics, and stenosis severity (MRA vs. HRMRI) were compared; risk factors were analyzed via multivariate analysis.
Main Results:
- Patients with apparent basilar artery plaque showed higher rates of diabetes mellitus, lower HDL, and elevated HbA1c, ESR, and homocysteine.
- HRMRI detected severe stenosis (>50%) in 43% of apparent plaque cases, compared to 16% by MRA.
- MRA underestimated stenosis, failing to detect significant stenosis in 13 patients with apparent plaque on HRMRI.
Conclusions:
- HRMRI provides more accurate detection of basilar artery stenosis with plaque than MRA.
- Risk factors associated with basilar artery plaque differ from those typically considered.
- HRMRI warrants increased attention for evaluating ICAS due to its superior diagnostic capability.
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