High-resolution vessel wall MRI and spectral CT in intracranial arterial occlusion: comparative diagnostic
Liangfan Jia1, Xiaona Li1, Yingshuai Zhang1,2
1Medical Imaging, Third Hospital of Hebei Medical University, Shijiazhuang, China.
Insights
High-resolution vessel wall MRI (HR-VWI) and spectral CT (SCT) accurately differentiate intracranial arterial plaque from thrombus. HR-VWI excels at plaque detection, while SCT is superior for thrombus identification, offering complementary diagnostic value.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Imaging
Background:
- Determining the cause of intracranial arterial occlusion (plaque vs. thrombus) is crucial for effective treatment but difficult with conventional imaging.
- Differentiating plaque from thrombus is essential for guiding therapeutic strategies in stroke patients.
Purpose of the Study:
- To compare the diagnostic performance of high-resolution vessel wall magnetic resonance imaging (HR-VWI) and spectral CT (SCT) in differentiating intracranial arterial plaque from thrombus.
- To evaluate the complementary roles of HR-VWI and SCT in identifying the etiology of arterial occlusion.
Main Methods:
- A retrospective study of 108 patients with cerebral infarction and intracranial arterial occlusion.
- Patients were divided into HR-VWI (n=54) and SCT (n=54) groups based on initial imaging.
- Diagnostic performance was assessed against histopathology or multidisciplinary consensus, with quantitative SCT parameters analyzed.
Main Results:
- Overall diagnostic accuracy was comparable: 90.74% for HR-VWI and 94.44% for SCT.
- HR-VWI showed higher sensitivity for plaque (100%) vs. SCT (86.96%).
- SCT demonstrated superior sensitivity for thrombus (100%) vs. HR-VWI (84.62%). Quantitative SCT parameters like standardized iodine concentration (nIC) were significantly higher in plaque occlusion (AUC=0.9355).
Conclusions:
- HR-VWI and SCT are highly accurate and complementary tools for determining intracranial arterial occlusion etiology.
- HR-VWI is advantageous for plaque characterization.
- SCT, with its quantitative biomarkers (e.g., nIC), is beneficial for rapid thrombus identification in acute stroke settings.
Purpose:
The etiology of intracranial arterial occlusion (plaque vs. thrombus) dictates treatment but is challenging to determine using conventional imaging. We aimed to compare the diagnostic performance of high-resolution vessel wall magnetic resonance imaging (HR-VWI) and spectral CT (SCT) for this differentiation.
Methods:
This retrospective study included 108 patients with cerebral infarction and intracranial arterial occlusion, classified into an HR-VWI group (n = 54) and an SCT group (n = 54) based on the first-line imaging modality. Using postoperative histopathology or multidisciplinary clinical consensus as the reference standard, the diagnostic performances of both techniques in differentiating plaque from thrombotic occlusion were compared. The quantitative parameters of SCT were analyzed.
Results:
The overall diagnostic accuracy of HR-VWI and SCT was comparable (90.74% vs. 94.44%). However, they exhibited complementary diagnostic strengths: HR-VWI demonstrated higher sensitivity in diagnosing plaque occlusion (100% vs. 86.96%), whereas SCT showed superior sensitivity in diagnosing thrombotic occlusion (100% vs. 84.62%). Quantitative analysis of SCT revealed that the standardized iodine concentration (nIC), effective atomic number (Zeff), and energy spectrum curve slope (λHU) in the plaque occlusion group were significantly higher than those in the thrombotic occlusion group (all p < 0.05), with nIC exhibiting the best diagnostic efficacy (AUC = 0.9355).
Conclusions:
HR-VWI and SCT are highly accurate and complementary for determining occlusion etiology. HR-VWI excels in plaque characterization, whereas SCT, with rapid acquisition and quantitative biomarkers like nIC, is advantageous for thrombus identification in acute settings.
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