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High-resolution MR vessel wall imaging in determining the stroke aetiology and risk stratification in isolated middle cerebral artery disease

  • Diagnostic Neuroradiology
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Abstract

Purpose

High-resolution MR vessel wall imaging (HRVWI) can characterise vessel wall pathology affecting intracranial circulation and helps in differentiating intracranial vasculopathies. The aim was to differentiate intracranial pathologies involving middle cerebral artery (MCA) in patients with ischemic stroke and characterise the high-risk plaques in intracranial atherosclerotic disease (ICAD) using HRVWI.

Methods

Patients with ischemic stroke with isolated MCA disease with ≥ 50% luminal narrowing by vascular imaging were enrolled within 2 weeks of onset and underwent high-resolution (3 T) intracranial vessel wall imaging (VWI). The pattern of vessel wall thickening, high signal on T1-weighted images, juxtaluminal hyperintensity, pattern and grade of enhancement were studied. The TOAST classification before and after HRVWI and the correlation of the recurrence of ischemic events at 3 months with imaging characteristics were analysed.

Results

Of the 36 patients, the mean age was 49.53 ± 15.61 years. After luminal imaging, by TOAST classification, 12 of 36 patients had stroke of undetermined aetiology. After vessel wall imaging, lesions in MCA were analysed. Of them, 23 patients had ICAD, 8 had vasculitis, and 2 had partially occlusive thrombus in MCA. The ability of HRVWI to bring a change in diagnosis was significant (p = 0.031). Of the 23 patients with ICAD, 12 patients had recurrent strokes within 3 months. The presence of grade 2 contrast enhancement (p = 0.02) and type 2 wall thickening (p = 0.03) showed a statistically significant association with recurrent ischemic events.

Conclusion

High-resolution MRVWI can help in identifying the aetiology of stroke. The HRVWI characteristics in ICAD can help in risk stratification.

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Data availability

Data can be made available upon request.

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Authors and Affiliations

  1. Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695 011, Kerala, India

    V. Tandon, S. E. Sreedharan & P. N. Sylaja

  2. Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India

    S. Senthilvelan & C. Kesavadas

  3. Department of Biostatistics, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India

    Jissa VT

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  1. V. Tandon
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  2. S. Senthilvelan
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  3. S. E. Sreedharan
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  4. C. Kesavadas
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  5. Jissa VT
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  6. P. N. Sylaja
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Contributions

(1) Conception and design of study. (2) Acquisition of data. (3) Analysis and interpretation of data. (4) Drafting the manuscript. (5) Critical revision for important intellectual content. (6) Final approval of the version to be published.

Corresponding author

Correspondence to P. N. Sylaja.

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This study received the ethics approval from the ethics committee of the institute.

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Tandon, V., Senthilvelan, S., Sreedharan, S.E. et al. High-resolution MR vessel wall imaging in determining the stroke aetiology and risk stratification in isolated middle cerebral artery disease. Neuroradiology 64, 1569–1577 (2022). https://doi.org/10.1007/s00234-021-02891-9

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