title: High-resolution magnetic resonance imaging reveals hidden etiologies of symptomatic vertebral arterial lesions.
abstract: BACKGROUND
  Symptomatic intracranial vertebral artery (VA) disease has various clinical features and poor neurological outcomes. The disease is believed to result from atherosclerotic stenosis, occlusion, or spontaneous VA dissection. The underlying histopathology of symptomatic intracranial VA disease has only been studied at postmortem, and no in vivo imaging investigation has been conducted despite the increased sophistication of imaging techniques.
  
  
  METHODS
  The authors performed high-resolution magnetic resonance imaging (HR-MRI) of intracranial vertebral arteries in 9 patients, suspected of a VA pathology by magnetic resonance imaging (MRI), magnetic resonance angiography, and digital subtraction angiography.
  
  
  RESULTS
  HR-MRI allowed the authors to determine the following: (1) atherosclerotic plaque is composed of a large lipid core with intraplaque hemorrhage and calcification, (2) nonstenotic atherosclerosis exhibits diffuse vessel wall thickening and plaque protruding toward perforating arteries, and (3) spontaneous VA dissection exhibits large intramural hematoma in a false lumen with complete occlusion of the true lumen. In addition, VA hypoplasia was easily differentiated from atherosclerotic stenosis, by direct visualization of a narrow lumen diameter without arterial wall thickening. Furthermore, etiologic diagnoses based on classical MRI, angiography, and digital subtraction angiography were changed in 3 patients after HR-MRI. Additional information on plaque stability, indicating the possibility of unstable plaque, was found in 4 patients.
  
  
  CONCLUSIONS
  The application of HR-MRI in stroke patients with VA pathologies enabled the authors to determine the underlying pathophysiologies. These findings could be used to improve risk stratification and treatment decision making in symptomatic intracranial VA disease.
authors.affiliation: Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea; Clinical Research Center for Stroke, Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Jong-Won
authors.initials: JW
authors.lastname: Chung
authors.affiliation: Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea; Clinical Research Center for Stroke, Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Neurology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.
authors.forename: Beom Joon
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.
authors.forename: Byung Se
authors.initials: BS
authors.lastname: Choi
authors.affiliation: Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Chul Ho
authors.initials: CH
authors.lastname: Sohn
authors.affiliation: Clinical Research Center for Stroke, Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Hee-Joon
authors.initials: HJ
authors.lastname: Bae
authors.affiliation: Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Byung-Woo
authors.initials: BW
authors.lastname: Yoon
authors.affiliation: Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: sb0516@snu.ac.kr.
authors.forename: Seung-Hoon
authors.initials: SH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D050197:Atherosclerosis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D002533:Cerebral Angiography / Q000379:methods; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000628:therapy; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D020217:Vertebral Artery Dissection / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy
keywords: Acute stroke; imaging; magnetic resonance imaging; plaque; posterior circulation; vertebral artery