title: An assessment on the incremental value of high-resolution magnetic resonance imaging to identify culprit plaques in atherosclerotic disease of the middle cerebral artery.
abstract: OBJECTIVE
  Although certain morphological features depicted by high resolution, multi-contrast magnetic resonance imaging (hrMRI) have been shown to be different between culprit and non-culprit middle cerebral artery (MCA) atherosclerotic lesions, the incremental value of hrMRI to define culprit lesions over stenosis has not been assessed.
  
  
  METHODS
  Patients suspected with MCA stenosis underwent hrMRI. Lumen and outer wall were segmented to calculate stenosis, plaque burden (PB), volume (PV), length (PL) and minimum luminal area (MLA).
  
  
  RESULTS
  Data from 165 lesions (112 culprit and 53 non-culprit) in 139 individuals were included. Culprit lesions were larger and longer with a narrower lumen and increased PB compared with non-culprit lesions. More culprit lesions showed contrast enhancement. Both PB and MLA were better indicators than stenosis in differentiating lesion types (AUC were 0.649, 0.732 and 0.737 for stenosis, PB and MLA, respectively). Combinations of PB, MLA and stenosis could improve positive predictive value (PPV) and specificity significantly. An optimal combination of stenosis ≥ 50 %, PB ≥ 77 % and MLA ≤ 2.0 mm(2) produced a PPV = 85.7 %, negative predictive value = 54.1 %, sensitivity = 69.6 %, specificity = 75.5 %, and accuracy = 71.5 %.
  
  
  CONCLUSIONS
  hrMRI plaque imaging provides incremental information to luminal stenosis in identifying culprit lesions.
  
  
  CONCLUSIONS
  • High resolution MRI provides incremental information in defining culprit MCA atherosclerotic lesions. • Both plaque burden and minimum luminal area are better indicators than stenosis. • An optimal combination includes stenosis ≥ 50 %, PB ≥ 77 % and MLA ≤ 2.0 mm (2) .
authors.affiliation: Department of Radiology, University of Cambridge, Level 5, Box 218, Hills Rd., Cambridge, CB2 0QQ, UK. zt215@cam.ac.uk.
authors.forename: Zhongzhao
authors.identifier: http://orcid.org/0000-0003-3973-6157
authors.initials: Z
authors.lastname: Teng
authors.affiliation: Department of Radiology, University of Cambridge, Level 5, Box 218, Hills Rd., Cambridge, CB2 0QQ, UK.|Department of Radiology, Changhai Hospital, 168 Changhai Rd, Shanghai, China, 200433.
authors.forename: Wenjia
authors.initials: W
authors.lastname: Peng
authors.affiliation: Department of Radiology, Changhai Hospital, 168 Changhai Rd, Shanghai, China, 200433.
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhan
authors.affiliation: Department of Radiology, Changhai Hospital, 168 Changhai Rd, Shanghai, China, 200433.
authors.forename: Xuefeng
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Changhai Hospital, 168 Changhai Rd, Shanghai, China, 200433.
authors.forename: Qi
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Department of Radiology, Changhai Hospital, 168 Changhai Rd, Shanghai, China, 200433.
authors.forename: Shiyue
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Radiology, Changhai Hospital, 168 Changhai Rd, Shanghai, China, 200433.
authors.forename: Xia
authors.initials: X
authors.lastname: Tian
authors.affiliation: Department of Radiology, Changhai Hospital, 168 Changhai Rd, Shanghai, China, 200433.
authors.forename: Luguang
authors.initials: L
authors.lastname: Chen
authors.affiliation: Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Brown
authors.affiliation: Department of Radiology, University of Cambridge, Level 5, Box 218, Hills Rd., Cambridge, CB2 0QQ, UK.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Graves
authors.affiliation: Department of Radiology, University of Cambridge, Level 5, Box 218, Hills Rd., Cambridge, CB2 0QQ, UK.
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Gillard
authors.affiliation: Department of Radiology, Changhai Hospital, 168 Changhai Rd, Shanghai, China, 200433. cjr.lujianping@vip.163.com.
authors.forename: Jianping
authors.initials: J
authors.lastname: Lu
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D002533:Cerebral Angiography; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D002537:Intracranial Arteriosclerosis / Q000000981:diagnostic imaging*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
keywords: Magnetic resonance imaging; Middle cerebral artery; Minimum luminal area; Plaque burden; Stenosis