Vessel wall MR imaging of intracranial atherosclerosis
Jae W Song1, Bruce A Wasserman2
1Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Insights
Intracranial atherosclerotic disease (ICAD) is a leading cause of ischemic stroke. High-resolution vessel wall MRI advances ICAD diagnosis and plaque characterization, improving stroke prognosis and treatment personalization.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Imaging
Background:
- Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke globally, associated with high recurrence rates, cognitive decline, and significant economic burden.
- Atherosclerotic lesions in intracranial arteries vary from subtle, angiographically occult changes to severe stenosis.
- Traditional imaging focuses on lumen diameter, often missing critical vessel wall pathology.
Purpose of the Study:
- To review the advantages of intracranial high-resolution vessel wall MRI (VW-MR) for characterizing ICAD.
- To explore the potential of VW-MR in identifying vulnerable intracranial plaques and assessing disease burden.
- To discuss the role of VW-MR in evaluating treatment response and future applications of AI in ICAD assessment.
Main Methods:
- Review of recent advancements in intracranial high-resolution vessel wall MR (VW-MR) imaging techniques.
- Discussion of how VW-MR enables characterization of vessel wall pathology beyond lumen imaging.
- Exploration of bioimaging markers and artificial intelligence in plaque assessment.
Main Results:
- Intracranial VW-MR allows detailed imaging of the vessel wall, revealing atherosclerotic changes.
- This technique can identify angiographically occult lesions and assess plaque vulnerability.
- VW-MR aids in evaluating treatment responses, such as to statin therapy, and understanding arterial remodeling.
Conclusions:
- Intracranial VW-MR imaging significantly enhances the understanding and diagnosis of ICAD.
- It offers potential for identifying vulnerable plaques and personalizing stroke treatment through lesion-based risk models.
- Future integration of AI with VW-MR promises improved lesion scoring and assessment for better patient outcomes.
Abstract:
Intracranial atherosclerotic disease (ICAD) is one of the most common causes of ischemic stroke worldwide. Along with high recurrent stroke risk from ICAD, its association with cognitive decline and dementia leads to a substantial decrease in quality of life and a high economic burden. Atherosclerotic lesions can range from slight wall thickening with plaques that are angiographically occult to severely stenotic lesions. Recent advances in intracranial high resolution vessel wall MR (VW-MR) imaging have enabled imaging beyond the lumen to characterize the vessel wall and its pathology. This technique has opened new avenues of research for identifying vulnerable plaque in the setting of acute ischemic stroke as well as assessing ICAD burden and its associations with its sequela, such as dementia. We now understand more about the intracranial arterial wall, its ability to remodel with disease and how we can use VW-MR to identify angiographically occult lesions and assess medical treatment responses, for example, to statin therapy. Our growing understanding of ICAD with intracranial VW-MR imaging can profoundly impact diagnosis, therapy, and prognosis for ischemic stroke with the possibility of lesion-based risk models to tailor and personalize treatment. In this review, we discuss the advantages of intracranial VW-MR imaging for ICAD, the potential of bioimaging markers to identify vulnerable intracranial plaque, and future directions of artificial intelligence and its utility for lesion scoring and assessment.
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