High-resolution vessel wall magnetic resonance imaging in intracranial vasculopathies: an experience from eastern
Shambaditya Das1, Mahmud Mossa-Basha2, Mousam Dey3
1Department of Neurology, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education & Research, Kolkata, India.
Insights
High-resolution intracranial vessel wall imaging (HR-IVWI) significantly improves the diagnosis of stroke causes. This advanced imaging technique aids in differentiating various intracranial vasculopathies, especially intracranial atherosclerotic disease.
Area of Science:
- Neurology
- Radiology
- Vascular Imaging
Background:
- Stroke remains a leading cause of disability and mortality worldwide.
- Accurate etiological classification of stroke is crucial for effective treatment and prognosis.
- Current diagnostic methods may not always fully differentiate various intracranial vasculopathies.
Purpose of the Study:
- To evaluate the role of high-resolution intracranial vessel wall imaging (HR-IVWI) in differentiating intracranial vasculopathies.
- To assess the impact of HR-IVWI on stroke classification in Indian patients.
- To compare HR-IVWI findings with clinical and luminal imaging assessments.
Main Methods:
- A single-center, cross-sectional study included 150 stroke or TIA patients.
- Patients were initially classified using TOAST and Chinese ischemic stroke sub-classification (CISS).
- Reclassification was performed after incorporating HR-IVWI findings.
Main Results:
- HR-IVWI led to significant changes in TOAST (10.7%) and CISS (14%) classifications (p < 0.001).
- Several cases initially classified as 'undetermined aetiology' were reclassified into ICAD, CNS angiitis, or arterial dissection.
- The diagnostic change was most pronounced in the intracranial atherosclerotic disease (ICAD) subgroup.
Conclusions:
- Adjunctive HR-IVWI significantly improves diagnostic accuracy for intracranial vasculopathies.
- HR-IVWI is particularly useful in diagnosing ICAD, CNS angiitis, and arterial dissection.
- This imaging modality offers clearer etiological distinctions with therapeutic and prognostic implications.
Objective:
To evaluate the role of high-resolution intracranial vessel wall imaging (HR-IVWI) in differentiation of various intracranial vasculopathies in addition to luminal and clinical imaging in the largest cohort of Indian stroke patients.
Methods:
A single-center, cross-sectional study was undertaken recruiting consecutive stroke or TIA patients presenting within a month of onset, with luminal irregularity/narrowing upstream from the stroke territory. The patients were initially classified into TOAST and Chinese ischemic stroke sub-classification (CISS) on the basis of clinical and luminal characteristics and reclassified again following incorporation of HR-IVWI findings.
Results:
In our cohort of 150 patients, additional use of HR-IVWI led to a 10.7 and 14% change in initial TOAST and CISS classification respectively (p < 0.001). In TOAST classification, 12 "undetermined aetiology" were reclassified into intracranial atherosclerotic disease (ICAD), 1 "undetermined aetiology" into CNS angiitis and 1 "undetermined aetiology" into arterial dissection. Similarly, in CISS 19 "undetermined aetiology" was reclassified into 16 large artery atherosclerosis (LAA) and 3 "other aetiology" consisting of one CNS angiitis, Moyamoya disease (MMD) and arterial dissection each. Two initial classification of MMD by CISS and TOAST were changed into ICAD. The observed change in diagnosis following incorporation of HR-IVWI was proportionately highest in ICAD (LAA) subgroup (TOAST-9.3%, CISS-12%).
Conclusion:
Adjunctive use of HR-IVWI, to clinical and luminal assessment, can significantly improve diagnostic accuracy during evaluation of intracranial vasculopathies, with its greatest utility in diagnosing in ICAD, CNS angiitis and dissection.
Advances In Knowledge:
HR-IVWI allows clearer etiological distinction of intracranial vasculopathies having therapeutic and prognostic implications.
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