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Plaque characteristics of middle cerebral artery assessed using strategically acquired gradient echo (STAGE) and vessel wall MR contribute to misery downstream perfusion in patients with intracranial atherosclerosis

  • Magnetic Resonance
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Abstract

Objectives

To assess plaque vulnerability of the middle cerebral artery (MCA) using strategically acquired gradient echo (STAGE) versus high-resolution vessel wall MRI (hr-vwMRI), and explore the relationship between plaque characteristics and misery downstream perfusion.

Methods

Ninety-one patients with single MCA atherosclerotic plaques underwent STAGE and hr-vwMRI were categorized into a group with misery perfusion and a group without based on the Alberta Stroke Program Early CT score (MTT-ASPECTS) with a threshold of 6. Plaque characteristics including inner lumen area (IWA), susceptibility, presence of hyperintensity within plaque (HIP), surface irregularity, stenosis degree, remodeling index, lipid ratio, and enhancement grade were compared between the two groups. The vulnerability of each plaque was retrospectively assessed on both STAGE and hr-vwMRI according to the combination of plaque features. Logistic regression analysis and ROC curve were performed to evaluate the effect of plaque characteristics on the presence of misery perfusion.

Results

Taking hr-vwMRI as the reference, STAGE showed good efficiency in detecting vulnerable plaques. Patients with misery perfusion had less IWA, higher stenosis degree, more irregular surface and HIP, higher enhancement grade, and susceptibility (p < 0.01 for all). Higher susceptibility and stenosis degree were independent predictors for the occurrence of misery perfusion (p = 0.025, p = 0.048). The AUC was 0.900 for the combination of the two variables.

Conclusion

STAGE shows good efficiency to assess MCA plaque vulnerability versus hr-vwMRI. Plaque susceptibility evaluated using STAGE provides incremental value to predict misery perfusion combined with hr-vwMRI plaque features.

Key Points

• STAGE has good efficiency in evaluating MCA plaque vulnerability versus hr-vwMRI.

• Higher plaque susceptibility assessed using STAGE and higher grade luminal stenosis based on hr-vwMRI attribute to misery downstream perfusion.

• STAGE provides incremental value on the understanding of plaque vulnerability in addition to conventional hr-vwMRI.

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Abbreviations

DSC-PWI:

Dynamic susceptibility contrast perfusion-weighted imaging

DWI:

Diffusion-weighted imaging

HP-phase:

High-pass phase

hr-vwMRI:

High-resolution vessel wall MRI

IPH:

Intraplaque hemorrhage

IR-SPACE:

Inversion-Recovery prepared Sampling Perfection with Application-optimized Contrast using different flip angle Evolutions

MCA:

Middle cerebral artery

MTT-ASPECTS:

Mean transit time maps according to the Alberta Stroke Program Early CT score

QSM:

Quantitative susceptibility mapping

SPIN:

Signal processing in nuclear magnetic resonance

STAGE:

Strategically acquired gradient echo

SWI:

Susceptibility-weighted imaging

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Funding

The authors have received grant support from the National Natural Science Foundation of China, contract grant numbers: 81871342, 81901728.

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Authors and Affiliations

  1. Radiology Department, First Central Clinical College, Tianjin Medical University, Tianjin, China

    Tong Zhang, Ruowei Tang, Song Liu & Chao Chai

  2. Radiology Department, Tianjin First Central Hospital, Number 24 of Fukang Road, Nankai District, Tianjin, China

    Tong Zhang, Ruowei Tang, Song Liu, Chao Chai & Shuang Xia

  3. The MRI Institute for Biomedical Research, Detroit, MI, USA

    Yongsheng Chen & E. Mark Haacke

  4. Department of Radiology, Wayne State University, Detroit, MI, USA

    Yongsheng Chen & E. Mark Haacke

Authors
  1. Tong Zhang
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  2. Ruowei Tang
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  3. Song Liu
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  4. Chao Chai
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  5. Yongsheng Chen
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  6. E. Mark Haacke
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  7. Shuang Xia
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Correspondence to Shuang Xia.

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The scientific guarantor of this publication is Shuang Xia.

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Zhang, T., Tang, R., Liu, S. et al. Plaque characteristics of middle cerebral artery assessed using strategically acquired gradient echo (STAGE) and vessel wall MR contribute to misery downstream perfusion in patients with intracranial atherosclerosis. Eur Radiol 31, 65–75 (2021). https://doi.org/10.1007/s00330-020-07055-6

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  • DOI: https://doi.org/10.1007/s00330-020-07055-6

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