Intracranial atherosclerosis: Review of imaging features and advances in diagnostics

Area of Science:

• Neurology
• Radiology
• Cardiovascular Science

Background:

• Intracranial atherosclerotic disease (ICAD) is a primary cause of ischemic stroke.
• Current diagnostic methods, focusing on stenosis, likely underestimate ICAD prevalence.
• Optimizing secondary stroke prevention requires detecting non-stenotic ICAD.

Purpose of the Study:

• To review current and emerging radiological techniques for characterizing symptomatic intracranial atherosclerotic disease.
• To highlight the limitations of traditional imaging in assessing ICAD.
• To emphasize the importance of advanced imaging for comprehensive ICAD evaluation.

Main Methods:

• Review of seminal trials and recent studies on advanced radiological techniques.
• Analysis of imaging modalities including computed tomography angiography (CTA) and magnetic resonance angiography (MRA).
• Exploration of emerging techniques like high-resolution MRA, quantitative MRA, and computational fluid dynamics.

Main Results:

• Computed tomography angiography and magnetic resonance angiography are standard for identifying stenotic atherosclerosis.
• These methods may not fully capture the extent of intracranial atherosclerosis.
• Advanced techniques show potential in revealing diverse pathophysiological mechanisms beyond stenosis.

Conclusions:

• Current diagnostic standards for intracranial atherosclerosis may be insufficient.
• Advanced imaging techniques offer promising avenues for more accurate ICAD detection.
• Improved detection of non-stenotic ICAD is crucial for refining secondary stroke prevention.