, Volume 61, Issue 6, pp 651–657 | Cite as

Temporal course and implications of intracranial atherosclerotic plaque enhancement on high-resolution vessel wall MRI

  • Robert M. Kwee
  • Ye Qiao
  • Li Liu
  • Steven R. Zeiler
  • Bruce A. WassermanEmail author
Diagnostic Neuroradiology



Little is known about the natural history of intracranial atherosclerotic plaque enhancement and its clinical implications. Our objective was to investigate the value of follow-up high-resolution contrast-enhanced vessel wall MRI (VWMRI) for classifying culprit plaques in patients with intracranial atherosclerotic disease (ICAD).


Fourteen patients with symptomatic ICAD (50% females; median age 48 years) underwent serial 3T VWMRI. Fifty-five plaques were identified and graded based on the likelihood of having caused the ischemic event (non-culprit, indeterminate, culprit) and degree of enhancement (0, 1, 2) at baseline and follow-up (median follow-up, 140 days). For accuracy analysis, plaque enhancement at baseline and stable or increasing plaque enhancement at follow-up was tested to identify a culprit plaque, and areas under the receiver operating characteristic curves (AUCs) were compared.


In 37/55 (67.3%) plaques, enhancement grade remained unchanged. Lack of enhancement was only seen in non-culprit plaques at baseline, and none developed enhancement over time. Enhancement never changed more than one grade. Thirty-seven percent (10/27) of non-culprit plaques that enhanced decreased in enhancement grade at follow-up, but no culprit plaques decreased in enhancement. AUC of baseline and follow-up plaque enhancement combined was significantly larger than AUC of baseline plaque enhancement alone to identify culprit plaques (0.733 vs. 0.567, p = 0.0001).


Contrast enhancement of ICAD can persist months after the ischemic event. Lack of enhancement at baseline or a decrease in enhancement at follow-up suggests that the plaque is not culprit. Persistent enhancement from baseline to follow-up improves accuracy in identifying culprit plaques.


Intracranial atherosclerosis Plaque Inflammation Enhancement High resolution Magnetic resonance imaging 



No funding was received for this study

Compliance with ethical standards

Conflict of interest

YQ and BAW have a patent pending (No. 13/922,111) for the 3D black blood MR imaging technique used in this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins HospitalBaltimoreUSA
  2. 2.Department of Radiology, Zuyderland Medical CenterHeerlen/Sittard/GeleenThe Netherlands
  3. 3.Department of NeurologyJohns Hopkins HospitalBaltimoreUSA

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