Detecting Basilar Artery Wall Pathology in Isolated Pontine Infarction With Short-TE SWI Magnitude Images.
Hon-Man Liu1,2, Adam Huang3, Chih-Hui Wu1
1Department of Medical Imaging (H.-M.L., C.-H.W., L.-S.H., N.Y., K.-C.L.), Fu Jen Catholic University Hospital, New Taipei City, Taiwan.
Stroke (Hoboken, N.J.)
|May 6, 2026
Summary
Short-echo time magnitude imaging (STE-MI) effectively detects basilar artery (BA) wall pathology and reduces artifacts in acute stroke patients. This advanced MRI technique aids in identifying nonstenotic intracranial atherosclerosis, improving diagnosis and risk stratification.
Area of Science:
- Neuroimaging
- Vascular Neurology
- Radiology
Background:
- Intracranial atherosclerotic ischemic stroke often presents with non-stenotic plaques, challenging current imaging techniques for vessel wall pathology detection.
- Existing methods struggle to effectively visualize cerebral microbleeds and reduce artifacts, particularly around the basilar artery (BA).
Purpose of the Study:
- To evaluate short-echo time susceptibility-weighted imaging magnitude images (STE-MI) for detecting cerebral microbleeds and minimizing artifacts around the BA.
- To assess the utility of STE-MI in identifying BA wall pathology in acute isolated pontine infarction, especially in nonstenotic, noncardioembolic stroke cases.
Main Methods:
- Retrospective analysis of a prospective observational study involving 3.0 T MRI with SWAN and STE-MI sequences.
- Evaluation of cerebral microbleed detection, artifact reduction, and vessel wall imaging quality, with interobserver agreement assessed using Cohen kappa.
- Analysis of clinical data, including risk factors and demographics, alongside imaging findings.
Main Results:
- STE-MI detected 86% of microbleeds identified by SWAN with excellent interobserver agreement (Cohen kappa=0.828).
- STE-MI significantly minimized blooming artifacts around the BA in 96.9% of cases compared to SWAN (P=3.469x10^-18).
- In patients with nonstenotic noncardioembolic isolated pontine infarction, 62.5% showed extraluminal BA pathology on STE-MI, correlating with diffusion-weighted imaging lesions (Cohen kappa=0.833). Triglycerides and smoking were significant risk factors.
Conclusions:
- STE-MI is effective in reducing artifacts and detecting BA wall pathology in acute isolated pontine infarction, particularly in nonstenotic noncardioembolic stroke.
- This imaging approach can enhance the identification of culprit lesions in intracranial atherosclerosis.
- STE-MI holds potential for improving risk stratification and guiding targeted therapeutic strategies for stroke patients.
