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Imaging endpoints of intracranial atherosclerosis using vessel wall MR imaging: a systematic review

  • Diagnostic Neuroradiology
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Abstract

Purpose

The vessel wall MR imaging (VWI) literature was systematically reviewed to assess the criteria and measurement methods of VWI-related imaging endpoints for symptomatic intracranial plaque in patients with ischemic events.

Methods

PubMed, Scopus, Web of Science, EMBASE, and Cochrane databases were searched up to October 2019. Two independent reviewers extracted data from 47 studies. A modified Guideline for Reporting Reliability and Agreement Studies was used to assess completeness of reporting.

Results

The specific VWI-pulse sequence used to identify plaque was reported in 51% of studies. A VWI-based criterion to define plaque was reported in 38% of studies. A definition for culprit plaque was reported in 40% of studies. Frequently scored qualitative imaging endpoints were plaque quadrant (21%) and enhancement (21%). Frequently measured quantitative imaging endpoints were stenosis (19%), lumen area (15%), and remodeling index (14%). Reproducibility for all endpoints ranged from good to excellent (range: ICCT1 hyperintensity = 0.451 to ICCstenosis = 0.983). However, rater specialty and years of experience varied among studies.

Conclusions

Investigators are using different criteria to identify and measure VWI-imaging endpoints for culprit intracranial plaque. Early awareness of these differences to address methods of acquisition and measurement will help focus research resources and efforts in technique optimization and measurement reproducibility. Consensual definitions to detect plaque will be important to develop automatic lesion detection tools particularly in the era of radiomics.

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Funding

This study was funded by the RSNA Research & Education Foundation (RSCH1929), Institute for Translational Medicine and Therapeutics/Thomas B. McCabe and Jeannette E. Laws McCabe Fund (JWS) and NIH National Heart, Lung, and Blood Institute R01HL147355 (ZF).

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Authors and Affiliations

  1. Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Jae W. Song, Athanasios Pavlou, Morgan P. Burke, Kofi-Buaku Atsina, Laurie A. Loevner & David Mankoff

  2. Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Haochang Shou

  3. Department of Biomedical Sciences, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Jiayu Xiao & Zhaoyang Fan

  4. Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Scott E. Kasner

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  1. Jae W. Song
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Contributions

Study conception and design: Jae W. Song and Scott E. Kasner. 

Material preparation, data collection, and analysis were performed by Jae W. Song, Athanasios Pavlou, Jiayu Xiao.

Writing-original draft preparation: Jae W Song.

Writing-review and editing: Athanasios Pavlou, Morgan P Burke, Haochang Shou, Kofi-Buaku Atsina, Jiayu Xiao, David Mankoff, Zhaoyang Fan, Scott E Kasner.

Funding acquisition: Jae W Song.

Resources: Jae W Song, Laurie A Loevner.

Supervision: Laurie A Loevner, David Mankoff, Zhaoyang Fan, Scott E Kasner.

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Correspondence to Jae W. Song.

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Song, J.W., Pavlou, A., Burke, M.P. et al. Imaging endpoints of intracranial atherosclerosis using vessel wall MR imaging: a systematic review. Neuroradiology 63, 847–856 (2021). https://doi.org/10.1007/s00234-020-02575-w

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