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Utility of intracranial high-resolution vessel wall magnetic resonance imaging in differentiating intracranial vasculopathic diseases causing ischemic stroke

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Purpose

High-resolution vessel wall imaging (HRVWI) by MRI is a novel noninvasive imaging tool which provides direct information regarding vessel wall pathologies. The utility of HRVWI in differentiating various intracranial vasculopathies among ischemic stroke is still evolving.

Methods

Consecutive ischemic stroke/TIA patients within 2 weeks of symptom onset between January 2016 to December 2017, with symptomatic vessel stenosis of 50% or more/occlusion on baseline luminal imaging studies were recruited into the study. Stroke subtypes were classified as per TOAST classification initially on the basis of luminal imaging findings alone and subsequently after incorporation of HRVWI findings as well.

Results

Forty-nine subjects were recruited into the study. The median age of the population was 42 years (range 11 to 75) with 69% being males. Incorporation of HRVWI findings classified 38.8% subjects into intracranial atherosclerotic disease (ICAD), 32.6% as stroke of other determined aetiology (ODE) (inflammatory vasculopathy [IVas] being the major subgroup [81.2%]) and 28.6% into stroke of undetermined aetiology (UE). HRVWI enabled a diagnostic reclassification in an additional 47.3% among the baseline UE category as against luminal imaging findings alone. ICAD was likelier to have eccentric vessel wall thickening, eccentric vessel wall enhancement and T2 juxtaluminal hyperintensity with surrounding hypointensity (P < 0.001), while IVas were more likely to exhibit concentric vessel wall thickening with homogenous enhancement (P < 0.001).

Conclusion

HRVWI is a useful noninvasive adjunctive tool in the diagnostic evaluation of intracranial vasculopathies, with maximum benefit in ICAD and IVas subtypes.

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Abbreviations

CTA:

Computed tomography angiography

MRA:

Magnetic resonance angiography

DSA:

Digital subtraction angiography

PACNS:

Primary angiitis of central nervous system

HRVWI:

High-resolution vessel wall magnetic resonance imaging

ICAD:

Intracranial atherosclerotic disease

RCVS:

Reversible cerebral vasoconstriction syndrome

TOAST:

Trial of Org 10172 in Acute Stroke Treatment

ODE:

Stroke of other determined aetiology

UE:

Stroke of undetermined aetiology

IVas:

Inflammatory vasculopathy

MMD:

Moyamoya disease

References

  1. Swartz RH, Bhuta SS, Farb RI et al (2009) Intracranial arterial wall imaging using high-resolution 3-Teslacontrast-enhanced MRI. Neurology 72:627–634

    Article  CAS  PubMed  Google Scholar 

  2. Alexander MD, Yuan C, Rutman A et al (2016) High-resolution intracranial vessel wall imaging: imaging beyond the lumen. J Neurol Neurosurg Psychiatry 87:589–597

    Article  PubMed  PubMed Central  Google Scholar 

  3. Thaler C, Kaufmann-Bühler AK, Gansukh T et al (2017) Neuroradiologic characteristics of primary angiitis of the central nervous system according to the affected vessel size. Clin Neuroradiol. https://doi.org/10.1007/s00062-017-0622-8

  4. Schuster S, Bachmann H, Thom V, Kaufmann-Buehler AK, Matschke J, Siemonsen S, Glatzel M, Fiehler J, Gerloff C, Magnus T, Thomalla G (2017) Subtypes of primary angiitis of the CNS identified by MRI patterns reflect the size of affected vessels. J Neurol Neurosurg Psychiatry 88(9):749–755

    Article  PubMed  Google Scholar 

  5. Mandell DM, Mossa-Basha M, Qiao Y et al (2017) Intracranial vessel wall MRI: principles and expert consensus recommendations of the American Society of Neuroradiology. AJNR Am J Neuroradiol 38:218–229

    Article  CAS  PubMed  Google Scholar 

  6. Jung SC, Kang DW, Turan TN (2016) Vessel and vessel wall imaging. Front Neurol Neurosci 40:109–123

    Article  PubMed  Google Scholar 

  7. Zhu XJ, Wang W, Liu ZJ (2016) High-resolution magnetic resonance vessel wall imaging for intracranial arterial stenosis. Chin Med J 129:1363–1370

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bhogal P, Navaei E, Makalanda HL et al (2016) Intracranial vessel wall MRI. Clin Radiol 71:293–303

    Article  CAS  PubMed  Google Scholar 

  9. Brinjikji W, Mossa-Basha M, Huston J, Rabinstein AA, Lanzino G, Lehman VT (2017) Intracranial vessel wall imaging for evaluation of steno-occlusive diseases and intracranial aneurysms. J Neuroradiol 44:123–134

    Article  PubMed  Google Scholar 

  10. Mossa-Basha M, Alexander M, Gaddikeri S, Yuan C, Gandhi D (2016) Vessel wall imaging for intracranial vascular disease evaluation. J Neurointerv Surg 8:1154–1159

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lehman VT, Brinjikji W, Kallmes DF et al (2016) Clinical interpretation of high-resolution vessel wall MRI of intracranial arterial diseases. Br J Radiol 89:20160496

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mossa-Basha M, Shibata DK, Hallam DK et al (2017) Added value of vessel wall magnetic resonance imaging for differentiation of nonocclusive intracranial vasculopathies. Stroke 48:3026–3033

    Article  PubMed  PubMed Central  Google Scholar 

  13. Adhithyan R, Kesav P, Thomas B, Sylaja PN, Kesavadas C (2018) High-resolution magnetic vessel wall imaging in cerebrovascular diseases. Neurol India 66:1124–1132

    Article  PubMed  Google Scholar 

  14. Koops A, Ittrich H, Petri S et al (2007) Multicontrast weighted magnetic resonance imaging of atherosclerotic plaques at 3.0 and 1.5 Tesla: ex-vivo comparison with histopathologic correlation. Eur Radiol 17:279–286

    Article  PubMed  Google Scholar 

  15. Majidi S, Sein J, Watanabe M et al (2013) Intracranial derived atherosclerosis assessment: an in vitro comparison between virtual histology by intravascular ultrasonography, 7T MRI, and histopathologic findings. AJNR Am J Neuroradiol 34:2259–2264

    Article  CAS  PubMed  Google Scholar 

  16. Salvarani C, Brown RD Jr, Calamia KT et al (2007) Primary central nervous system vasculitis: analysis of 101 patients. Ann Neurol 62:442–451

    Article  PubMed  Google Scholar 

  17. Mossa-Basha M, Hwang WD, De Havenon A et al (2015) Multicontrast high-resolution vessel wall magnetic resonance imaging and its value in differentiating intracranial vasculopathic processes. Stroke 46:1567–1573

    Article  PubMed  Google Scholar 

  18. Debette S, Compter A, Labeyrie MA et al (2015) Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection. Lancet Neurol 14(6):640–654

    Article  PubMed  Google Scholar 

  19. 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 24:35–41

    Article  Google Scholar 

  20. Lindenholz A, van der Kolk AG, Zwanenburg JJM, Hendrikse J (2018) The uses and pitfalls of intracranial vessel wall imaging: how do we do it. Radiology 286:12–28

    Article  PubMed  Google Scholar 

  21. Qiao Y, Zeiler SR, Mirbagheri S et al (2014) Intracranial plaque enhancement in patients with cerebrovascular events on high-spatial-resolution MR images. Radiology 271:534–542

    Article  PubMed  PubMed Central  Google Scholar 

  22. Wong LK (2006) Global burden of intracranial atherosclerosis. Int J Stroke 1:158–159

    Article  PubMed  Google Scholar 

  23. Xu WH, Li ML, Gao S et al (2010) In vivo high-resolution MR imaging of symptomatic and asymptomatic middle cerebral artery atherosclerosis stenosis. Atherosclerosis 212:507–511

    Article  CAS  PubMed  Google Scholar 

  24. Harris KG, Tran DD, Sickels WJ, Cornell SH, Yuh WT (1994) Diagnosing intracranial vasculitis: the roles of MR and angiography. AJNR Am J Neuroradiol 15:317–330

    CAS  PubMed  Google Scholar 

  25. Birnbaum J, Hellmann DB (2009) Primary angiitis of the central nervous system. Arch Neurol 66:704–709

    Article  PubMed  Google Scholar 

  26. Asranna AP, Kesav P, Nagesh C, Sreedharan SE, Kesavadas C, Sylaja PN (2017) Cerebral aneurysms and metastases occurring as a delayed complication of resected atrial myxoma: imaging findings including high resolution vessel wall MRI. Neuroradiology 59(5):427–429

    Article  PubMed  Google Scholar 

  27. Kalsoum E, ChabernaudNegrier A, Tuilier T et al (2018) Blood flow mimicking aneurysmal wall enhancement: a diagnostic pitfall of vessel wall MRI using the post contrast 3D turbo spin echo MR imaging sequence. AJNR Am J Neuroradiol 39:1065–1067

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, 695011, India

    Praveen Kesav, Sapna E. Sreedharan, Sajith Sukumaran & P. N. Sylaja

  2. Department of Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India

    Balamurali Krishnavadana, Chandrasekharan Kesavadas & Adhithyan Rajendran

Authors
  1. Praveen Kesav
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  2. Balamurali Krishnavadana
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  3. Chandrasekharan Kesavadas
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  4. Sapna E. Sreedharan
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  5. Adhithyan Rajendran
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  6. Sajith Sukumaran
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  7. P. N. Sylaja
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Correspondence to P. N. Sylaja.

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The authors declare that they have no conflict of interest.

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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.

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

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Kesav, P., Krishnavadana, B., Kesavadas, C. et al. Utility of intracranial high-resolution vessel wall magnetic resonance imaging in differentiating intracranial vasculopathic diseases causing ischemic stroke. Neuroradiology 61, 389–396 (2019). https://doi.org/10.1007/s00234-019-02157-5

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  • DOI: https://doi.org/10.1007/s00234-019-02157-5

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