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Updated: Oct 19, 2025
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
Vessel wall magnetic resonance imaging in COVID-19-associated cryptogenic ischemic stroke
Federico Mazzacane1,2, Antonio Zito2, Serena Magno1
1Department of Emergency Neurology and Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy.
Insights
Vessel wall MRI revealed inflammation in most cryptogenic stroke patients with COVID-19. This suggests vessel wall imaging may enhance diagnosis and treatment for these acute ischemic stroke cases.
Area of Science:
- Neurology
- Radiology
- Infectious Diseases
Background:
- Acute ischemic stroke (AIS) is a known complication of COVID-19.
- The biological mechanisms linking COVID-19 and AIS are not fully understood.
Purpose of the Study:
- To investigate vessel wall alterations in cryptogenic stroke patients using vessel wall MRI (vwMRI).
- To explore the prevalence of vascular inflammation in AIS patients with COVID-19.
Main Methods:
- Prospective evaluation of AIS patients with COVID-19.
- Comprehensive etiologic workup for AIS.
- Vessel wall MRI (vwMRI) for cryptogenic stroke cases.
Main Results:
- Ten patients were included; four (40%) had cryptogenic stroke.
- vwMRI detected intracranial artery wall inflammation in 75% of cryptogenic stroke patients.
- Inflammation patterns included focal and multifocal involvement.
Conclusions:
- vwMRI identified vascular inflammation in most cryptogenic AIS patients, aiding etiological definition.
- Findings suggest vwMRI could be a valuable addition to the diagnostic workup for cryptogenic stroke.
- This research is hypothesis-generating, prompting further investigation into COVID-19's impact on cerebrovasculature.
Background And Purpose:
Acute ischemic stroke (AIS) is a common complication of coronavirus disease 2019 (COVID-19), but the underlying biological mechanisms remain unclear. We aimed to describe the prevalence of vessel wall alterations in patients with cryptogenic stroke through vessel wall magnetic resonance imaging (vwMRI).
Methods:
All consecutive patients admitted for AIS and COVID-19 to a single neuro-COVID unit from 10 November to 31 December 2020 were prospectively evaluated and underwent a complete etiologic workup for AIS. In patients with cryptogenic stroke, the diagnostic workup was completed with vwMRI study.
Results:
After the exclusion of four patients ineligible for MRI, a total of 10 patients were included (median age = 78 years, 50% males), of whom four (40%) had a cryptogenic stroke. vwMRI showed vascular changes consistent with inflammation of intracranial artery walls in three subjects (75%). Two patients had focal and one multifocal involvement.
Conclusions:
vwMRI detected signs of vascular inflammation in the majority of patients with cryptogenic AIS, leading to an etiologic definition with potential therapeutical implications. Our findings are best interpreted as hypothesis-generating, suggesting the possibility of expanding the diagnostic workup of cryptogenic stroke with vessel wall imaging.
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