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Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
High-Resolution Intracranial Vessel Wall MRI Findings Among Different Middle Cerebral Artery Territory Infarction
So Yeon Won1, Jihoon Cha2, Hyun Seok Choi3
1Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Objective:
Intracranial atherosclerotic stroke occurs through various mechanisms, mainly by artery-to-artery embolism (AA) or branch occlusive disease (BOD). This study evaluated the spatial relationship between middle cerebral artery (MCA) plaques and perforating arteries among different MCA territory infarction types using vessel wall magnetic resonance imaging (VW-MRI).
Materials And Methods:
We retrospectively enrolled patients with acute MCA infarction who underwent VW-MRI. Thirty-four patients were divided into three groups according to infarction pattern: 1) BOD, 2) both BOD and AA (BOD-AA), and 3) AA. To determine the factors related to BOD, the BOD and BOD-AA groups were combined into one group (with striatocapsular infarction [BOD+]) and compared with the AA group. To determine the factors related to AA, the BOD-AA and AA groups were combined into another group (with cortical infarction [AA+]) and compared with the BOD group. Plaque morphology and the spatial relationship between the perforating artery orifice and plaque were evaluated both quantitatively and qualitatively.
Results:
The plaque margin in the BOD+ group was closer to the perforating artery orifice than that in the AA group (p = 0.011), with less enhancing plaque (p = 0.030). In the BOD group, plaques were mainly located on the dorsal (41.2%) and superior (41.2%) sides where the perforating arteries mainly arose. No patient in the AA group had overlapping plaques with perforating arteries at the cross-section where the perforator arose. Perforating arteries associated with culprit plaques were most frequently located in the middle two-thirds of the M1 segment (41.4%). The AA+ group had more stenosis (%) than the BOD group (39.73 ± 24.52 vs. 14.42 ± 20.96; p = 0.003).
Conclusion:
The spatial relationship between the perforating artery orifice and plaque varied among different types of MCA territory infarctions. In patients with BOD, the plaque margin was closer and blocked the perforating artery orifice, and stenosis degree and enhancement were less than those in patients with AA.
Insights
Vessel wall MRI reveals that in middle cerebral artery (MCA) strokes, plaque location relative to perforating arteries differs between artery-to-artery embolism (AA) and branch occlusive disease (BOD). BOD plaques are closer to perforating arteries, suggesting a distinct mechanism.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Research
Background:
- Intracranial atherosclerotic stroke is a significant cause of disability.
- Mechanisms include artery-to-artery embolism (AA) and branch occlusive disease (BOD).
- Understanding plaque-perforator relationships is crucial for stroke mechanism elucidation.
Purpose of the Study:
- To investigate the spatial relationship between middle cerebral artery (MCA) plaques and perforating arteries.
- To differentiate these relationships based on MCA infarction patterns (BOD, AA, or mixed).
- To utilize vessel wall magnetic resonance imaging (VW-MRI) for detailed plaque and perforator assessment.
Main Methods:
- Retrospective analysis of 34 acute MCA infarction patients undergoing VW-MRI.
- Classification into BOD, BOD-AA, and AA groups based on infarction patterns.
- Comparison of plaque morphology and spatial proximity to perforating artery origins between groups.
- Analysis of plaque characteristics (stenosis, enhancement) and location.
Main Results:
- Plaque margins were closer to perforating artery orifices in the BOD+ group compared to the AA group (p=0.011).
- Less plaque enhancement was observed in the BOD+ group (p=0.030).
- In BOD, plaques predominantly affected dorsal/superior aspects where perforators arise; AA showed no overlapping plaques at perforator origins. AA+ group had significantly more stenosis than BOD group (p=0.003).
Conclusions:
- The spatial relationship between MCA plaques and perforating arteries differs significantly between BOD and AA stroke mechanisms.
- In BOD, plaques are spatially associated with perforating artery origins, suggesting local occlusion.
- VW-MRI provides insights into stroke etiology by visualizing these intricate vascular relationships.
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