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Updated: Sep 2, 2025
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Predictive value of the combination between the intracranial arterial culprit plaque characteristics and the Essen
Kaixuan Ren1, Huayun Jiang1, Tiantian Li1
1Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, China.
Insights
High-resolution MRI reveals that T1-weighted imaging hyperintensity in culprit plaques, combined with the European Stroke Registry Score (ESRS), effectively predicts short-term stroke recurrence in patients with intracranial atherosclerotic stenosis. This finding offers a simpler diagnostic approach.
Area of Science:
- Neuroimaging
- Vascular Neurology
- Cardiovascular Imaging
Background:
- Symptomatic intracranial atherosclerotic stenosis (sICAS) poses a significant risk for stroke recurrence.
- Identifying high-risk plaques is crucial for timely intervention and stroke prevention.
- High-resolution magnetic resonance vessel wall imaging (HR-MR-VWI) offers detailed visualization of intracranial plaques.
Purpose of the Study:
- To identify culprit plaque characteristics in intracranial arteries using HR-MR-VWI.
- To evaluate the predictive value of these plaque characteristics, combined with the European Stroke Registry Score (ESRS), for short-term stroke recurrence.
Main Methods:
- Prospective cohort study of 342 patients with sICAS.
- HR-MR-VWI was used to assess culprit vessel and plaque characteristics.
- Six-month follow-up data were analyzed using Cox regression and ROC curves to determine predictive performance.
Main Results:
- Stroke recurrence occurred in 15.5% of patients within six months.
- Independent risk factors for recurrence included ESRS, degree of plaque enhancement, and T1-weighted imaging (T1WI) hyperintensity.
- The combination of ESRS and T1WI hyperintensity demonstrated the highest predictive ability (AUC=0.745) for stroke recurrence.
Conclusions:
- T1WI hyperintensity in culprit plaques, when combined with ESRS, shows superior predictive value for short-term stroke recurrence.
- This combined approach offers a clinically valuable and simpler method for precise stroke risk assessment in sICAS patients.
Aim:
In the current study we aim the identification of the culprit plaque characteristics of intracranial arteries using high-resolution magnetic resonance vessel wall imaging (HR-MR-VWI). Moreover, we target the evaluation of the predictive value of culprit plaque characteristics for short-term stroke recurrence combined with ESRS.
Materials And Methods:
We conducted a prospective cohort study on 342 patients diagnosed with symptomatic intracranial atherosclerotic stenosis (sICAS), out of which 243 were men and 99 were women with an average age of 64 ± 12 years. 184 cases of anterior circulation ischemia (ACIS) and 158 cases of posterior circulation ischemia (PCIS) were included in the study. All of them underwent HR-MR-VWI during the period between February 2020 and June 2021 in the Second Affiliated Hospital of Nantong University, Nantong, China. The culprit vessel and culprit plaque characteristics were assessed based on HR-MR-VWI images, and the patients' ESRS were obtained from the electronic medical records of the hospital. Concerning the obtained results from the 6-month follow-up, the patients were divided into the non-recurrence group and the recurrence group, and the differences in the above-mentioned features between the two groups were compared. The univariate Cox regression analysis combined with ESRS was performed to screen out the independent risk factors associated with recurrent stroke with P < 0.1. Receiver operating characteristic curves (ROC curves) were plotted to analyze the predictive performance of the culprit plaque characteristics, ESRS and combined variables for stroke recurrence. We used the area under the curve (AUC) ROC, while the sensitivity and specificity were calculated at the optimal threshold. The Delong test was employed to compare the quality of the AUC of the predictors.
Results:
A total of 15.5% (53/342) of patients had a stroke recurrence within six months, with statistically significant differences (P < 0.05) between the two groups regarding the ESRS, medical history of diabetes mellitus, myocardial infarction, data for previous acute ischemic stroke (AIS) or transient ischemic attack(TIA), history of peripheral vascular disease, and serum brain natriuretic peptide level. In the patients with ACIS, the incidence of hyperintensity on the T1-weighted imaging (T1WI) was significantly different between the recurrence and the non-recurrence groups (P < 0.05). In the patients with PCIS, statistically significant differences between the recurrence and the non-recurrence group were detected in the culprit plaque burden, degree of enhancement, and incidence of hyperintensity on T1WI (P < 0.05). The ESRS (hazard ratios [HR], 1.598, 95% confidence interval [CI], 1.193-2.141, P = 0.002) ,degree of enhancement (HR = 1.764, 95% CI 0.985-3.087, P = 0.047) and hyperintensity on T1WI (HR = 2.745, 95% CI 1.373-5.488, P = 0.004) proved to be independent risk factors for stroke recurrence. The ESRS predicted stroke recurrence with AUC = 0.618 (95% CI 0.564-0.670), while the best cut-off value was 2 points. Furthermore, the registered sensitivity and specificity were 60.4% and 58.5%, respectively. Regarding the degree of enhancement in the culprit plaque, the prediction of stroke recurrence was with AUC = 0.628 (95% CI 0.574-0.679) as well as with sensitivities and specificities of 58.5% and 64.4%, respectively. Regarding the hyperintensity on T1WI in culprit plaque, the prediction of stroke recurrence was with AUC = 0.678 (95% CI 0.626-0.727) as well as with sensitivities and specificities of 66.0% and 70.0%, respectively. The ESRS combined with the degree of enhancement predicted stroke recurrence with an AUC = 0.685 (95CI% 0.633-0.734), while the recorded sensitivity and specificity were 56.6% and 73.4%, respectively. The ESRS combined with hyperintensity on the T1WI predicted stroke recurrence with an AUC = 0.745 (95CI% 0.696-0.791). The recorded sensitivity and specificity were 64.2% and 76.8%, respectively. The AUC quality of the ESRS combined with hyperintensity on T1WI was higher than that of other indices (P < 0.05).
Conclusions:
The hyperintensity on T1WI of the culprit plaque in intracranial arteries combined with ESRS demonstrated better predictive ability for short-term stroke recurrence. We consider this of high importance for clinical application since it provides an easier way of obtaining data for precise diagnosis.
