High-resolution MR vessel wall imaging in determining the stroke aetiology and risk stratification in isolated middle
V Tandon1, S Senthilvelan2, S E Sreedharan1
1Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695 011, Kerala, India.
Insights
High-resolution MR vessel wall imaging (HRVWI) helps differentiate stroke causes and identify high-risk plaques in intracranial atherosclerotic disease (ICAD). HRVWI characteristics are associated with recurrent ischemic events, aiding in stroke risk stratification.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Imaging
Background:
- Intracranial circulation pathologies can cause ischemic stroke.
- Differentiating vasculopathies is crucial for effective treatment.
- High-resolution MR vessel wall imaging (HRVWI) offers detailed characterization of vessel walls.
Purpose of the Study:
- To differentiate intracranial pathologies of the middle cerebral artery (MCA) in ischemic stroke patients.
- To characterize high-risk plaques in intracranial atherosclerotic disease (ICAD) using HRVWI.
- To assess the diagnostic and prognostic value of HRVWI in MCA disease.
Main Methods:
- Patients with ≥50% MCA stenosis underwent 3T HRVWI within 2 weeks of ischemic stroke onset.
- Analysis included vessel wall thickening, T1 signal, juxtaluminal hyperintensity, and enhancement patterns.
- TOAST classification was performed before and after HRVWI, correlating imaging findings with 3-month recurrent ischemic events.
Main Results:
- HRVWI significantly changed diagnosis in 36 patients (p=0.031).
- ICAD was diagnosed in 23 patients, vasculitis in 8, and thrombus in 2.
- Grade 2 enhancement (p=0.02) and type 2 wall thickening (p=0.03) in ICAD were associated with recurrent strokes.
Conclusions:
- HRVWI is valuable for identifying stroke etiology.
- HRVWI characteristics in ICAD aid in risk stratification for recurrent events.
- This imaging technique improves diagnostic accuracy and patient management.
Purpose:
High-resolution MR vessel wall imaging (HRVWI) can characterise vessel wall pathology affecting intracranial circulation and helps in differentiating intracranial vasculopathies. The aim was to differentiate intracranial pathologies involving middle cerebral artery (MCA) in patients with ischemic stroke and characterise the high-risk plaques in intracranial atherosclerotic disease (ICAD) using HRVWI.
Methods:
Patients with ischemic stroke with isolated MCA disease with ≥ 50% luminal narrowing by vascular imaging were enrolled within 2 weeks of onset and underwent high-resolution (3 T) intracranial vessel wall imaging (VWI). The pattern of vessel wall thickening, high signal on T1-weighted images, juxtaluminal hyperintensity, pattern and grade of enhancement were studied. The TOAST classification before and after HRVWI and the correlation of the recurrence of ischemic events at 3 months with imaging characteristics were analysed.
Results:
Of the 36 patients, the mean age was 49.53 ± 15.61 years. After luminal imaging, by TOAST classification, 12 of 36 patients had stroke of undetermined aetiology. After vessel wall imaging, lesions in MCA were analysed. Of them, 23 patients had ICAD, 8 had vasculitis, and 2 had partially occlusive thrombus in MCA. The ability of HRVWI to bring a change in diagnosis was significant (p = 0.031). Of the 23 patients with ICAD, 12 patients had recurrent strokes within 3 months. The presence of grade 2 contrast enhancement (p = 0.02) and type 2 wall thickening (p = 0.03) showed a statistically significant association with recurrent ischemic events.
Conclusion:
High-resolution MRVWI can help in identifying the aetiology of stroke. The HRVWI characteristics in ICAD can help in risk stratification.
