Assessment of Intracranial Atherosclerotic Plaques Using 3D Black-Blood MRI: Comparison With 3D Time-of-Flight MRA
Xia Tian1,2, Bing Tian2, Zhang Shi2
1Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Background:
Noninvasive assessment of intracranial stenosis is important to manage ischemic stroke patients. However, few previous studies have compared 3D black-blood MRI with 3D time-of-flight (TOF), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA) for intracranial artery plaque assessment.
Purpose:
To compare 3D black-blood MRI and 3D TOF-MRA, using DSA as the reference standard for intracranial stenosis and atherosclerotic plaque assessment in patients with posterior circulation stroke or transient ischemic attacks (TIAs).
Study Type:
Prospective, cohort study.
Population:
One hundred and one patients with posterior circulation stroke and/or TIA (age 63 ± 10 years, 84 male) who underwent DSA and MRI within 4 weeks of each other.
Field Strength/Sequence:
3D fast-spin-echo MRI for intracranial vessel wall imaging (IVWI) and 3D TOF at 3T.
Assessment:
Two radiologists independently measured the degree of stenosis on 3D IVWI and TOF, using DSA as a reference. Plaque enhancement was recorded when the plaque was stenosis-free on DSA.
Statistical Tests:
Shapiro-Wilk's test, Student's t-test, Mann-Whitney U-test, Spearman correlation, Bland-Altman analysis, and interclass correlation coefficient (ICC).
Results:
A total of 238 intracranial plaques (203 posterior, 35 anterior) were included. 3D IVWI showed better agreement with DSA in measuring stenosis than TOF (ICC = 0.89 vs. 0.64). 3D IVWI had higher sensitivity and specificity for detecting stenosis >50% and stenosis >75% than TOF, using DSA as the standard. TOF significantly overestimated the degree of stenosis compared to DSA (65 ± 19% vs. 51 ± 15%, P < 0.001). DSA did not observe 62 nonstenotic plaques (26.1%) that were shown only on 3D IVWI, in which 36 plaques (58.1%) showed contrast enhancement. The interreader agreement for measuring stenosis were excellent, with ICCs >0.90 for all three modalities.
Data Conclusion:
3D black-blood MRI is accurate and reproducible for quantifying intracranial artery stenosis compared with DSA, and performs better than 3D TOF. As compared to DSA, it detects more nonstenotic plaques. Level of Evidence 1 Technical Efficacy Stage 2 J. MAGN. RESON. IMAGING 2021;53:469-478.
Insights
3D black-blood MRI accurately quantifies intracranial stenosis and plaque compared to digital subtraction angiography (DSA), outperforming 3D time-of-flight (TOF) MRA. This advanced MRI technique also identifies non-stenotic plaques missed by DSA.
Area of Science:
- Neuroimaging
- Vascular Neurology
- Radiology
Background:
- Noninvasive assessment of intracranial stenosis is crucial for managing ischemic stroke.
- Limited comparative studies exist for 3D black-blood MRI versus 3D TOF-MRA and DSA in intracranial artery plaque assessment.
Purpose of the Study:
- To compare 3D black-blood MRI and 3D TOF-MRA for intracranial stenosis and plaque assessment.
- To utilize digital subtraction angiography (DSA) as the reference standard in patients with posterior circulation stroke or transient ischemic attacks (TIAs).
Main Methods:
- Prospective cohort study of 101 patients with posterior circulation stroke/TIA.
- Comparison of 3D intracranial vessel wall imaging (IVWI) and 3D TOF MRI at 3T against DSA.
- Independent radiologist assessment of stenosis and plaque enhancement, with interreader agreement analysis.
Main Results:
- 3D IVWI demonstrated superior agreement with DSA for stenosis measurement (ICC=0.89) compared to TOF (ICC=0.64).
- 3D IVWI exhibited higher sensitivity and specificity for detecting significant stenosis (>50%, >75%) than TOF.
- TOF overestimated stenosis (65%±19%) versus DSA (51%±15%), P<0.001; 3D IVWI identified 62 non-stenotic plaques missed by DSA.
Conclusions:
- 3D black-blood MRI (IVWI) is accurate and reproducible for quantifying intracranial artery stenosis, outperforming 3D TOF.
- 3D IVWI offers advantages over DSA by detecting non-stenotic plaques with potential enhancement.
- This technique provides a valuable noninvasive tool for evaluating intracranial atherosclerosis in stroke patients.
