Characterisation of symptomatic intracranial plaque without substantial stenosis using high-resolution vessel wall
1Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
Aim:
To characterise symptomatic intracranial plaque without substantial stenosis using three-dimensional (3D) high-resolution contrast-enhanced black-blood magnetic resonance imaging (BBMRI) and to determine plaque features associated with recent cerebrovascular events.
Materials And Methods:
The institutional review board approved this retrospective study. The case notes from patients with evidence of intracranial atherosclerosis in a large intracranial artery with preceding BBMRI were reviewed retrospectively. Symptomatic and asymptomatic plaques with substantial luminal stenosis (<50%) were matched by plaque location and patient age. All MRI images were de-identified and interpreted by two neuroradiologists who were blinded to the history of symptoms. Qualitative analyses including the presence of intraplaque haemorrhage (IPH), eccentricity, surface irregularity, and grade of plaque enhancement were recorded. Quantitative analyses including normal wall index and degree of contrast enhancement were calculated. Multivariate regression analysis was performed to identify the association with cerebrovascular ischaemic events.
Results:
A total of 38 pairs of symptomatic and asymptomatic plaques from 74 patients were analysed. Compared to asymptomatic plaques, symptomatic plaques demonstrated higher degree of contrast enhancement (29.77 ± 19.23 versus 18.21 ± 12.18%, p=0.039) and presence of IPH (26% versus 8%, p=0.032). No significant differences were detected regarding eccentricity, surface irregularity, and normal wall index. Events were associated with contrast enhancement (OR, 1.212; 95% confidence interval [CI], 1.086-1.352) after controlling for age, sex, cardiovascular risk factors, and stenosis degree. IPH was not associated with events.
Conclusion:
Contrast enhancement in the intracranial plaque without substantial stenosis is associated with previous events, and may serve as the vulnerable feature, thereby stratifying stroke risk not achievable by luminal stenosis.
Insights
Contrast enhancement in intracranial plaques without significant stenosis indicates a higher risk of cerebrovascular events. This imaging feature, identified by black-blood MRI, helps stratify stroke risk beyond traditional stenosis measurements.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Research
Background:
- Intracranial atherosclerosis is a significant cause of stroke.
- Characterizing plaque vulnerability is crucial for stroke risk stratification.
- Current imaging methods may not fully capture the risk associated with non-stenotic plaques.
Purpose of the Study:
- To characterize symptomatic intracranial plaques without significant stenosis using 3D high-resolution contrast-enhanced black-blood MRI (BBMRI).
- To identify plaque features associated with recent cerebrovascular events.
- To evaluate the utility of BBMRI in assessing stroke risk.
Main Methods:
- Retrospective analysis of 38 pairs of symptomatic and asymptomatic intracranial plaques from 74 patients.
- Utilized 3D high-resolution contrast-enhanced BBMRI to assess plaque features.
- Qualitative and quantitative analyses included intraplaque hemorrhage (IPH), contrast enhancement, and normal wall index.
- Multivariate regression analysis identified associations with cerebrovascular ischemic events.
Main Results:
- Symptomatic plaques showed significantly higher contrast enhancement (29.77% vs 18.21%) and IPH (26% vs 8%) compared to asymptomatic plaques.
- Contrast enhancement was significantly associated with cerebrovascular events (OR, 1.212; 95% CI, 1.086-1.352) after controlling for confounders.
- No significant differences were found in eccentricity, surface irregularity, or normal wall index between symptomatic and asymptomatic plaques.
Conclusions:
- Contrast enhancement in intracranial plaques without substantial stenosis is a marker of vulnerability.
- This imaging feature aids in stratifying stroke risk, offering insights beyond luminal stenosis.
- BBMRI can identify vulnerable plaques and improve stroke risk assessment in patients with intracranial atherosclerosis.
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