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High Resolution Magnetic Resonance Vessel Wall Imaging: A Valuable Addition to Stroke Work-Up.

Grace Adwane1, Alexia Tran2, Pierre Seners1,3

  • 1Department of Neurology, Hopital Fondation Adolphe de Rothschild, Paris, France.

European Journal of Neurology
|March 6, 2026
PubMed
Summary

High-Resolution Vessel Wall (HRVW) MRI significantly impacts ischemic stroke (IS) etiological classification and influences treatment decisions. This advanced imaging technique aids in determining stroke causes and guiding patient management.

Keywords:
intracranial high‐resolution vessel wall MRIintracranial stenosisischemic strokestroke of undetermined etiologyvasculitis

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Area of Science:

  • Neurology
  • Radiology
  • Cardiovascular Imaging

Background:

  • Intracranial High-Resolution Vessel Wall (HRVW) MRI is an advanced imaging technique used in ischemic stroke (IS) work-up.
  • Its precise clinical utility and therapeutic implications in IS patients remain under investigation.

Purpose of the Study:

  • To evaluate the findings of intracranial HRVW-MRI in IS patients.
  • To assess the impact of HRVW-MRI on IS etiological classification using the TOAST criteria.
  • To determine the influence of HRVW-MRI on subsequent treatment modifications.

Main Methods:

  • Retrospective analysis of consecutive IS patients who underwent intracranial HRVW-MRI within two weeks of stroke onset.
  • HRVW-MRI was utilized for patients with intracranial stenosis or undetermined stroke etiology.
  • Comparison of TOAST classification and treatment changes before and after HRVW-MRI.

Main Results:

  • HRVW-MRI modified the TOAST classification in 17% of 316 included patients.
  • Strokes attributed to atheromatous origin increased from 28.2% to 38.3% (p < 0.001).
  • Therapeutic changes were prompted in 7% of cases following HRVW-MRI.

Conclusions:

  • Intracranial HRVW-MRI significantly alters ischemic stroke etiological classification.
  • HRVW-MRI findings have direct implications for patient treatment management.
  • Further prospective studies are needed to confirm the clinical utility of HRVW-MRI in IS work-up.