Characterization of intracranial atherosclerotic stenosis using high-resolution MRI study--rationale and design
Tanya N Turan1, Todd LeMatty1, Renee Martin2
1Department of Neurology Medical University of South Carolina Charleston South Carolina.
Insights
High-resolution MRI can identify intracranial atherosclerotic plaque components, crucial for understanding stroke risk. This study aims to establish the reliability of this imaging technique for future clinical applications in stroke prevention.
Area of Science:
- Neurology
- Cardiovascular Imaging
- Radiology
Background:
- Intracranial atherosclerosis is a major cause of stroke, yet plaque composition and morphology's link to stroke risk remain unclear.
- High-resolution magnetic resonance imaging (HR MRI) successfully identifies plaque components in carotid atherosclerosis, predicting recurrent stroke.
- Current understanding of intracranial plaque composition using HR MRI lacks reproducibility and interrater reliability data.
Purpose of the Study:
- To establish high interrater agreement for identifying intracranial plaque components using HR MRI.
- To compare the frequency of plaque components in symptomatic versus asymptomatic intracranial atherosclerosis.
- To estimate the 1-year stroke rate associated with high-risk plaque components in intracranial stenosis.
Main Methods:
- The Characterization of intracranial atherosclerotic stenosis using high-resolution MRI (CHIASM) study is a prospective, single-center observational trial.
- Recruitment of 90 patients with 50-99% intracranial atherosclerosis for HR MRI at baseline and 1-year follow-up.
- Inclusion of both symptomatic and asymptomatic individuals to assess plaque characteristics in different clinical presentations.
Main Results:
- This section is not available in the provided abstract.
Conclusions:
- Establishing interrater reliability for HR MRI in intracranial atherosclerosis is a critical step towards its use in risk prediction.
- Findings will guide future multicenter studies on the prevalence and prognosis of intracranial atherosclerotic plaque components.
- This research may enhance understanding of cerebral ischemia mechanisms and improve risk stratification and treatment for atherosclerotic intracranial stenosis.
Background:
Intracranial atherosclerosis is a leading cause of stroke, but little is known about the composition of the intracranial atherosclerotic lesion and how intracranial plaque morphology is related to the risk of stroke. High-resolution magnetic resonance imaging (HR MRI) has been used in patients with extracranial carotid atherosclerosis as an in vivo tool to identify, with high-interrater agreement, histologically defined plaque components (i.e., intraplaque hemorrhage, fibrous cap, and lipid core), which have been shown to be predictors of recurrent stroke. With careful imaging the components of atherosclerotic plaque can be visualized in the intracranial arteries using HR MRI, but there are no reports of reproducibility or interrater reliability.
Methods/Study Design:
The Characterization of intracranial atherosclerotic stenosis using high-resolution MRI (CHIASM) study is a single-center NIH-funded prospective observational study, to (1) demonstrate high -interrater agreement for identifying intracranial plaque components on HR MRI, (2) determine the frequency of these components in symptomatic versus asymptomatic plaques, and (3) estimate the 1-year rate of stroke in the territory of high-risk plaque components. CHIASM will recruit 90 patients with 50-99% intracranial atherosclerosis to undergo HRMRI of the intracranial artery plaque at enrollment and 1-year follow-up. Both symptomatic and asymptomatic subjects will be recruited.
Conclusion:
Determination of good interrater reliability is an important first step in the development of HR MRI as a tool to predict risk in patients with intracranial atherosclerosis. This study will inform the design of future multicenter studies to determine the prevalence and prognosis of intracranial atherosclerotic plaque components. Such studies could lead to new understanding of the pathophysiological mechanisms of cerebral ischemia in patients with atherosclerotic intracranial stenosis, improvements in risk stratification, and potentially to new treatments of this common and serious disease.
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