title: Evaluating middle cerebral artery atherosclerotic lesions in acute ischemic stroke using magnetic resonance T1-weighted 3-dimensional vessel wall imaging.
abstract: BACKGROUND
  Atherosclerotic lesions in intracranial arteries are a leading cause of ischemic stroke. Magnetic resonance angiography (MRA) is often used to assess atherosclerotic changes by detecting luminal narrowing, whereas it cannot directly visualize atherosclerotic lesions. Here, we used a 3-dimensional vessel wall imaging (3D-VWI) technique to evaluate intracranial arterial wall changes in acute stroke.
  
  
  METHODS
  Eighteen consecutive patients with acute noncardioembolic stroke in the middle cerebral artery (MCA) territory who were prospectively examined with a 1.5-T magnetic resonance scanner were studied. T1-weighted (T1-W) 3D-VWI was obtained using a flow-sensitized 3D fast-spin echo technique. Wall thickening of MCA that suggests atherosclerotic plaques was visually evaluated and the contrast ratio (CR) of signal intensity of the lesions to that of the corpus callosum was calculated and compared with stenotic changes by MRA.
  
  
  RESULTS
  Wall thickenings of the MCA ipsilateral and contralateral to the lesion were observed in almost all patients on 3D-VWI (94.4% and 94.4%, respectively), whereas MRA showed stenotic changes of 50% only in 1 patient (5.9%; P < .001). The CR of the thickened wall in the ipsilateral MCA was significantly higher than that in the contralateral MCA (median, .53 and .45, respectively; P = .028), suggesting of unstable plaques consisting of hemorrhage or lipid.
  
  
  CONCLUSIONS
  The T1-W 3D-VWI can provide direct visualization of atherosclerotic lesions of the intracranial arteries in stroke patients, and it can detect signal change suggestive of unstable plaque.
authors.affiliation: Department of Neurology and Gerontology, Iwate Medical University, Morioka, Japan. Electronic address: tnatori@iwate-med.ac.jp.
authors.forename: Tatsunori
authors.initials: T
authors.lastname: Natori
authors.affiliation: Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Morioka, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Sasaki
authors.affiliation: GE Healthcare, Tokyo, Japan.
authors.forename: Mitsuharu
authors.initials: M
authors.lastname: Miyoshi
authors.affiliation: Department of Neurology and Gerontology, Iwate Medical University, Morioka, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ohba
authors.affiliation: Department of Neurology and Gerontology, Iwate Medical University, Morioka, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Katsura
authors.affiliation: Department of Neurology and Gerontology, Iwate Medical University, Morioka, Japan.
authors.forename: Mao
authors.initials: M
authors.lastname: Yamaguchi
authors.affiliation: Department of Neurology and Gerontology, Iwate Medical University, Morioka, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Narumi
authors.affiliation: GE Healthcare, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kabasawa
authors.affiliation: Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Morioka, Japan.
authors.forename: Kohsuke
authors.initials: K
authors.lastname: Kudo
authors.affiliation: Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Morioka, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Ito
authors.affiliation: Department of Neurology and Gerontology, Iwate Medical University, Morioka, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Terayama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000139:chemically induced / Q000473:pathology*; D003251:Constriction, Pathologic / Q000473:pathology; D017352:Echo-Planar Imaging / Q000379:methods; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D002537:Intracranial Arteriosclerosis / Q000175:diagnosis / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology*; D020521:Stroke / Q000175:diagnosis / Q000473:pathology*
keywords: Acute stroke; atherosclerosis; intracranial artery; magnetic resonance imaging