, Volume 57, Issue 10, pp 1007–1013 | Cite as

Non-stenotic intracranial arteries have atherosclerotic changes in acute ischemic stroke patients: a 3T MRI study

  • Woo Jin Lee
  • Hyun Seok Choi
  • Jinhee Jang
  • Jinkyeong Sung
  • Tae-Won Kim
  • Jaseong Koo
  • Yong Sam Shin
  • So-Lyung Jung
  • Kook-Jin Ahn
  • Bum-soo Kim
Diagnostic Neuroradiology



The aim of this study is to evaluate the degree of atherosclerotic changes in intracranial arteries by assessing arterial wall thickness using T1-weighted 3D-turbo spin echo (3D-TSE) and time-of-flight MR angiography (TOF-MRA) in patients with acute ischemic stroke as compared with unaffected controls.


Thirty-three patients with acute ischemic stroke and 36 control patients were analyzed. Acute ischemic stroke patients were divided according to TOAST classification. At both distal internal carotid arteries and basilar artery without stenosis, TOF-MRA was used to select non-stenotic portion of assessed arteries. 3D-TSE was used to measure the area including the lumen and wall (AreaOuter) and luminal area (AreaInner). The area of the vessel wall (AreaVW) of assessed intracranial arteries and the ratio index (RI) of each patient were determined.


AreaInner, AreaOuter, AreaVW, and RI showed good inter-observer reliability and excellent intra-observer reliability. AreaInner did not significantly differ between stroke patients and controls (P = 0.619). However, AreaOuter, AreaVW, and RI were significantly larger in stroke patients (P < 0.001). The correlation coefficient between AreaInner and AreaOuter was higher in the controls (r = 0.918) than in large vessel disease patients (r = 0.778). RI of large vessel disease patients was significantly higher than that of normal control, small vessel disease, and cardioembolic groups.


In patients with acute ischemic stroke, wall thickening and positive remodeling are evident in non-stenotic intracranial arteries. This change is more definite in stroke subtype that is related to atherosclerosis than that in other subtypes which are not.


Atherosclerosis Ischemic stroke Intracranial atherosclerosis MR angiography 


Ethical standards and patient consent

We declare that all human studies have been approved by the Institutional Review Board and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that the Institutional Review Board waived consent.

Conflict of interest

We declare that we have no conflict of interest.


  1. 1.
    Sacco RL, Kargman DE, Zamanillo MC (1995) Race-ethnic differences in stroke risk factors among hospitalized patients with cerebral infarction: the northern Manhattan stroke study. Neurology 45(4):659–663CrossRefPubMedGoogle Scholar
  2. 2.
    Wityk RJ, Lehman D, Klag M, Coresh J, Ahn H, Litt B (1996) Race and sex differences in the distribution of cerebral atherosclerosis. Stroke 27(11):1974–1980CrossRefPubMedGoogle Scholar
  3. 3.
    Wong LK (2006) Global burden of intracranial atherosclerosis. Int J Stroke 1(3):158–159CrossRefPubMedGoogle Scholar
  4. 4.
    Mazighi M, Labreuche J, Gongora-Rivera F, Duyckaerts C, Hauw JJ, Amarenco P (2008) Autopsy prevalence of intracranial atherosclerosis in patients with fatal stroke. Stroke 39(4):1142–1147CrossRefPubMedGoogle Scholar
  5. 5.
    Dieleman N, van der Kolk AG, Zwanenburg JJ et al (2014) Imaging intracranial vessel wall pathology with magnetic resonance imaging: current prospects and future directions. Circulation 130(2):192–201CrossRefPubMedGoogle Scholar
  6. 6.
    Chimowitz MI, Lynn MJ, Howlett-Smith H et al (2005) Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 352(13):1305–1316CrossRefPubMedGoogle Scholar
  7. 7.
    Kasner SE, Chimowitz MI, Lynn MJ et al (2006) Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis. Circulation 113(4):555–563CrossRefPubMedGoogle Scholar
  8. 8.
    Wong KS, Lam WW, Liang E, Huang YN, Chan YL, Kay R (1996) Variability of magnetic resonance angiography and computed tomography angiography in grading middle cerebral artery stenosis. Stroke 27(6):1084–1087CrossRefPubMedGoogle Scholar
  9. 9.
    Suwanwela NC, Phanthumchinda K, Suwanwela N (2002) Transcranial doppler sonography and CT angiography in patients with atherothrombotic middle cerebral artery stroke. AJNR Am J Neuroradiol 23(8):1352–1355PubMedGoogle Scholar
  10. 10.
    Ryu CW, Jahng GH, Kim EJ, Choi WS, Yang DM (2009) High resolution wall and lumen mri of the middle cerebral arteries at 3 tesla. Cerebrovasc Dis 27(5):433–442CrossRefPubMedGoogle Scholar
  11. 11.
    Klein IF, Lavallee PC, Mazighi M, Schouman-Claeys E, Labreuche J, Amarenco P (2010) Basilar artery atherosclerotic plaques in paramedian and lacunar pontine infarctions: a high-resolution MRI study. Stroke 41(7):1405–1409CrossRefPubMedGoogle Scholar
  12. 12.
    Swartz RH, Bhuta SS, Farb RI et al (2009) Intracranial arterial wall imaging using high-resolution 3-tesla contrast-enhanced MRI. Neurology 72(7):627–634CrossRefPubMedGoogle Scholar
  13. 13.
    van der Kolk AG, Zwanenburg JJ, Brundel M et al (2011) Intracranial vessel wall imaging at 7.0-T MRI. Stroke 42(9):2478–2484CrossRefPubMedGoogle Scholar
  14. 14.
    Qiao Y, Zeiler SR, Mirbagheri S et al (2014) Intracranial plaque enhancement in patients with cerebrovascular events on high-spatial-resolution MR images. Radiology 271(2):534–542PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Klein IF, Lavallee PC, Touboul PJ, Schouman-Claeys E, Amarenco P (2006) In vivo middle cerebral artery plaque imaging by high-resolution MRI. Neurology 67(2):327–329CrossRefPubMedGoogle Scholar
  16. 16.
    Ma N, Jiang WJ, Lou X et al (2010) Arterial remodeling of advanced basilar atherosclerosis: a 3-tesla MRI study. Neurology 75(3):253–258CrossRefPubMedGoogle Scholar
  17. 17.
    Adams HP Jr, Bendixen BH, Kappelle LJ et al (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. Toast. Trial of org 10172 in acute stroke treatment. Stroke 24(1):35–41CrossRefPubMedGoogle Scholar
  18. 18.
    Wj C (1999) Practical nonparametric statistics, 3rd edn. Wiley, New YorkGoogle Scholar
  19. 19.
    Kim YS, Lim SH, Oh KW et al (2012) The advantage of high-resolution MRI in evaluating basilar plaques: a comparison study with MRA. Atherosclerosis 224(2):411–416CrossRefPubMedGoogle Scholar
  20. 20.
    Varnava AM, Mills PG, Davies MJ (2002) Relationship between coronary artery remodeling and plaque vulnerability. Circulation 105(8):939–943CrossRefPubMedGoogle Scholar
  21. 21.
    Shi MC, Wang SC, Zhou HW et al (2012) Compensatory remodeling in symptomatic middle cerebral artery atherosclerotic stenosis: a high-resolution MRI and microemboli monitoring study. Neurol Res 34(2):153–158PubMedGoogle Scholar
  22. 22.
    Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG (2009) New approach to stroke subtyping: the A-S-C-O (phenotypic) classification of stroke. Cerebrovasc Dis 27(5):502–508CrossRefPubMedGoogle Scholar
  23. 23.
    Niranjan B, Vasily LY, Baocheng C, Jinnan W, Thomas H, Chun Y (2011) Carotid plaque assessment using fast 3d isotropic resolution black-blood mri. Magn Reson Med 65(3):627–637CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Woo Jin Lee
    • 1
  • Hyun Seok Choi
    • 1
  • Jinhee Jang
    • 1
  • Jinkyeong Sung
    • 1
  • Tae-Won Kim
    • 2
  • Jaseong Koo
    • 2
  • Yong Sam Shin
    • 3
  • So-Lyung Jung
    • 1
  • Kook-Jin Ahn
    • 1
  • Bum-soo Kim
    • 1
  1. 1.Department of Radiology, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
  2. 2.Department of Neurology, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
  3. 3.Department of Neurosurgery, College of MedicineThe Catholic University of KoreaSeoulSouth Korea

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