Visualization of basilar artery atherosclerotic plaques by conventional T2-weighted magnetic resonance imaging: A
Mi Ji Lee1, Soohyun Cho1, Jihoon Cha2
1Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Objective:
In vivo visualization of intracranial atherosclerotic plaque has been performed only with high-resolution magnetic resonance imaging (HRMR). We investigated whether atherosclerotic plaque of the basilar artery (BA) can be identified in conventional magnetic resonance imaging (MRI).
Methods:
Patients with acute ischemic stroke who had BA stenosis ("symptomatic BAA") were retrospectively recruited using the prospective stroke registry. In the HRMR databank, subjects without BA stenosis were recruited and classified as those with silent plaque ("silent BAA") and without any plaque ("normal controls"). Outer diameter of the BA and T2 plaque sign (an eccentric or complete obscuration of normal flow-void) within the BA were assessed by two blinded raters using conventional T2 MRI.
Results:
Seventy-five patients with symptomatic BAA, 40 with asymptomatic BAA, and 36 normal controls were included in the study. Maximal BA diameter was significantly larger in symptomatic BAA patients with <30%, 30-50%, 50-70%, and >70% stenosis (all p<0.01 in each subgroup) and silent BAA subjects (p = 0.018) than controls. T2 plaque signs were present in 46 (61.3%) patients with symptomatic BAA and 6 (14.6%) subjects with asymptomatic BAA, while none in normal controls (p <0.001 and 0.057, respectively). Detection rates were increased with an increase in stenosis degree (25.0% in <30% stenosis, 57.9% in 30-50% stenosis, 38.5% in 50-70% stenosis, 92.3% in 70-99% stenosis, and 100.0% in occlusion).
Conclusions:
Our data suggest that BA atherosclerosis can be detected by conventional MRI. When the use of HRMR is limited, conventional MR imaging may give additive information to clinicians.
Insights
Conventional MRI can detect basilar artery (BA) atherosclerosis, a common cause of stroke. This finding is crucial for diagnosing symptomatic and silent BA atherosclerosis when high-resolution MRI is unavailable.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Science
Background:
- Intracranial atherosclerotic plaque visualization traditionally relies on high-resolution magnetic resonance imaging (HRMR).
- Basilar artery (BA) atherosclerosis is a significant risk factor for ischemic stroke.
Purpose of the Study:
- To investigate the capability of conventional magnetic resonance imaging (MRI) in identifying atherosclerotic plaque within the basilar artery (BA).
- To assess the utility of conventional T2 MRI in detecting BA atherosclerosis.
Main Methods:
- Retrospective analysis of patients with acute ischemic stroke and BA stenosis (symptomatic BAA).
- Inclusion of subjects with silent plaque (silent BAA) and normal controls from an HRMR databank.
- Assessment of BA outer diameter and T2 plaque signs by two blinded raters using conventional T2 MRI.
Main Results:
- Maximal BA diameter was significantly larger in symptomatic BAA and silent BAA groups compared to controls.
- T2 plaque signs were identified in 61.3% of symptomatic BAA patients and 14.6% of asymptomatic BAA subjects.
- Plaque detection rates increased with the degree of BA stenosis, reaching 100% in cases of occlusion.
Conclusions:
- Conventional MRI is capable of detecting BA atherosclerosis.
- Conventional MR imaging provides valuable additive information for clinicians, especially when HRMR is not accessible.
- This study highlights the potential of conventional MRI in diagnosing BA atherosclerosis and guiding clinical decisions.
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