Related Experiment Video
Updated: Jun 13, 2025
Brain Infarct Segmentation and Registration on MRI or CT for Lesion-symptom Mapping
Published on: September 25, 2019
Evaluation of Middle Cerebral Artery Culprit Plaque Inflammation in Ischemic Stroke Using CAIPIRINHA-Dixon-TWIST
Junxia Niu1,2, Yuncai Ran2, Rui Chen2
1Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Background:
Middle cerebral artery (MCA) plaques are a leading cause of ischemic stroke (IS). Plaque inflammation is crucial for plaque stability and urgently needs quantitative detection.
Purpose:
To explore the utility of Controlled Aliasing in Parallel Imaging Results in Higher Acceleration (CAIPIRINHA)-Dixon-Time-resolved angiography With Interleaved Stochastic Trajectories (TWIST) (CDT) dynamic contrast-enhanced MRI (DCE-MRI) for evaluating MCA culprit plaque inflammation changes over stroke time and with diabetes mellitus (DM).
Study Type:
Prospective.
Population:
Ninety-four patients (51.6 ± 12.23 years, 32 females, 23 DM) with acute IS (AIS; N = 43) and non-acute IS (non-AIS; 14 days < stroke time ≤ 3 months; N = 51).
Field Strength/Sequence:
3-T, CDT DCE-MRI and three-dimensional (3D) Sampling Perfection with Application optimized Contrast using different flip angle Evolution (3D-SPACE) T1-weighted imaging (T1WI).
Assessment:
Stroke time (from initial IS symptoms to MRI) and DM were registered. For 94 MCA culprit plaques, Ktrans from CDT DCE-MRI and enhancement ratio (ER) from 3D-SPACE T1WI were compared between groups with and without AIS and DM.
Statistical Tests:
Shapiro-Wilk test, Bland-Altman analysis, Passing and Bablok test, independent t-test, Mann-Whitney U test, Chi-squared test, Fisher's exact test, receiver operating characteristics (ROC) with the area under the curve (AUC), DeLong's test, and Spearman rank correlation test with the P-value significance level of 0.05.
Results:
Ktrans and ER of MCA culprit plaques were significantly higher in AIS than non-AIS patients (Ktrans = 0.098 s-1 vs. 0.037 s-1; ER = 0.86 vs. 0.55). Ktrans showed better AUC for distinguishing AIS from non-AIS patients (0.87 vs. 0.75) and stronger negative correlation with stroke time than ER (r = -0.60 vs. -0.34). DM patients had significantly higher Ktrans and ER than non-DM patients in IS and AIS groups.
Data Conclusion:
Imaging by CDT DCE-MRI may allow to quantitatively evaluate MCA culprit plaques over stroke time and DM.
Evidence Level:
2 TECHNICAL EFFICACY: Stage 2.
Insights
Controlled Aliasing in Parallel Imaging Results in Higher Acceleration (CAIPIRINHA)-Dixon-Time-resolved angiography With Interleaved Stochastic Trajectories (TWIST) (CDT) dynamic contrast-enhanced MRI (DCE-MRI) can quantitatively assess middle cerebral artery (MCA) plaque inflammation. This technique shows higher plaque activity in acute ischemic stroke and diabetes mellitus patients.
Area of Science:
- Neuroimaging
- Radiology
- Cardiovascular Research
Background:
- Middle cerebral artery (MCA) plaques are a primary cause of ischemic stroke (IS).
- Quantitative detection of plaque inflammation is critical for assessing plaque stability.
Purpose of the Study:
- To evaluate the effectiveness of CAIPIRINHA-Dixon-TWIST (CDT) DCE-MRI in assessing MCA culprit plaque inflammation.
- To analyze changes in plaque inflammation over stroke time and in patients with diabetes mellitus (DM).
Main Methods:
- Prospective study involving 94 patients with acute or non-acute IS.
- Utilized 3-T CDT DCE-MRI and 3D-SPACE T1-weighted imaging (T1WI) to assess MCA plaques.
- Statistical analyses included t-tests, Mann-Whitney U, ROC analysis, and correlation tests.
Main Results:
- MCA plaque Ktrans and enhancement ratio (ER) were significantly higher in acute IS patients compared to non-acute IS patients.
- Ktrans demonstrated superior accuracy (AUC=0.87) in differentiating acute from non-acute IS and correlated more strongly with stroke time.
- Diabetes mellitus patients exhibited higher Ktrans and ER values, indicating increased plaque inflammation.
Conclusions:
- CDT DCE-MRI offers a quantitative method for evaluating MCA culprit plaque inflammation.
- The technique is sensitive to changes related to stroke time and the presence of diabetes mellitus.
