Evaluation of basilar artery atherosclerotic plaque distribution by 3D MR vessel wall imaging
Zhensen Chen1, Ao-Fei Liu2, Huijun Chen1
1Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China.
Insights
Basilar artery atherosclerosis commonly affects lateral walls and distal segments near the AICA, crucial for preventing perforator strokes. Understanding plaque distribution aids in targeted treatment strategies.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Science
Background:
- Basilar artery (BA) atherosclerosis is a key cause of brainstem perforator stroke.
- Plaque involvement of perforator ostia in the BA dorsal or lateral walls contributes to stroke.
- Understanding BA plaque distribution is vital for preventing perforator stroke.
Purpose of the Study:
- To comprehensively evaluate basilar artery plaque distribution using 3D magnetic resonance imaging (MRI) vessel wall imaging.
- To correlate plaque distribution with the risk of perforator stroke.
Main Methods:
- Recruited patients with cerebrovascular symptoms and BA stenosis or irregular luminal surface.
- Utilized 3D proton density-weighted volume isotropic turbo spin echo acquisition (VISTA) imaging at 3T.
- Analyzed cross-sectional and longitudinal plaque distribution with a custom tool.
Main Results:
- Detected 85 BA plaques in 61 patients.
- Plaque prevalence: ventral (74.1%), left (70.6%), dorsal (67.1%), right (62.4%).
- Most severe plaques were on lateral walls (66.1%) vs. ventral (23.2%) and dorsal (10.6%).
- Plaques were more frequent distal to the anterior inferior cerebellar artery (AICA) (63.5%).
Conclusions:
- 3D MR vessel wall imaging effectively characterized BA plaque distribution.
- BA plaques predominantly affect lateral walls and distal segments near AICA.
- Characterizing BA plaque distribution is crucial for preventing perforator stroke.
Purpose:
Basilar artery (BA) atherosclerosis is an important cause of perforator stroke in the brainstem due to plaque involvement of the perforator ostia in BA dorsal or lateral walls. Therefore, to acquire information on plaque distribution is important to better understand and prevent the perforator stroke. This study aimed to comprehensively evaluate BA plaque distribution with 3D magnetic resonance imaging (MRI) vessel wall imaging.
Materials And Methods:
Consecutive patients with cerebrovascular symptoms and stenosis or irregular luminal surface of BA were recruited and underwent BA 3D proton density-weighted volume isotropic turbo spin echo acquisition (VISTA) imaging at 3T. The cross-sectional and longitudinal distribution of BA plaque were analyzed with a custom-developed tool.
Results:
In all, 85 BA plaques were detected in 61 recruited patients. For cross-sectional distribution, the prevalence of plaque involvement in the ventral, left, dorsal, and right quadrant of BA wall was 74.1%, 70.6%, 67.1%, and 62.4%, respectively. Of the 85 plaques, 17.7% involved one quadrant and 82.3% involved two or more quadrants. The most severe plaque region was more commonly situated at lateral walls (66.1%) as compared to ventral (23.2%, P < 0.001) and dorsal walls (10.6%, P < 0.001). Longitudinally, plaques were more frequently found to occur at BA segment distal than proximal to anterior inferior cerebellar artery (AICA) (63.5% vs. 36.5%).
Conclusion:
Taking advantage of 3D MR vessel wall imaging, BA plaques were found to more likely affect lateral walls and form in BA distal to AICA, where most perforators originate, suggesting that it might be useful to characterize BA plaque distribution before aggressive treatment for prevention of perforator stroke. J. Magn. Reson. Imaging 2016;44:1592-1599.
