title: Intracranial plaque enhancement from high resolution vessel wall magnetic resonance imaging predicts stroke recurrence.
abstract: BACKGROUND
  Intracranial atherosclerosis is associated with frequent stroke recurrence. High resolution vessel wall magnetic resonance imaging (HRMRI) can provide atheroma information related to its vulnerability.
  
  
  OBJECTIVE
  We performed HRMRI in stroke patients with intracranial atherosclerosis to determine whether plaque characteristics from vessel wall imaging can predict future stroke recurrence.
  
  
  METHODS
  Between July 2011 and June 2013, acute stroke patients with symptomatic intracranial atherosclerosis were prospectively enrolled and 3-tesla HRMRI was performed on the relevant artery. The plaque enhancement was visually determined from T1 post-gadolinium enhancement image. Stroke recurrence was monitored after index event and multivariate Cox proportional hazards model was constructed to identify factors related to future stroke recurrence.
  
  
  RESULTS
  A total of 138 patients were included with a median follow-up of 18 months. There were 39 stroke recurrences. Plaque enhancement was detected in 108 patients (78.3%), and 37 of them experienced stroke recurrence. Among 30 stroke patients without plaque enhancement, two patients experienced stroke recurrence. Kaplan-Meier curves demonstrated a significant difference in event free survival between the patients with plaque enhancement and those patients without plaque enhancement (event rates at year 1: 30.3% vs. 6.8%, log-rank test, p = 0.004). Multivariate Cox-regression analysis showed that the plaque enhancement from HRMRI was independently associated with stroke recurrence (hazard ratio: 7.42, 95% confidence interval: 1.74-31.75, p = 0.007).
  
  
  CONCLUSIONS
  Intracranial plaque enhancement from HRMRI is associated with stroke recurrence among the patients with symptomatic intracranial atherosclerosis.
authors.affiliation: Department of Neurology, Chung-Ang University Hospital, Seoul, South Korea.
authors.forename: Jeong-Min
authors.initials: JM
authors.lastname: Kim
authors.affiliation: Department of Neurology, Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Keun-Hwa
authors.initials: KH
authors.lastname: Jung
authors.affiliation: Department of Radiology, Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Chul-Ho
authors.initials: CH
authors.lastname: Sohn
authors.affiliation: Department of Neurology, Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Jangsup
authors.initials: J
authors.lastname: Moon
authors.affiliation: Department of Neurology, Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Jung-Hwan
authors.initials: JH
authors.lastname: Shin
authors.affiliation: Department of Biomedical Engineering, Sungkyunkwan University, Suwon, South Korea.
authors.forename: Jaeseok
authors.initials: J
authors.lastname: Park
authors.affiliation: Department of Neurology, Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Seung-Hoon
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Radiology, Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Moon Hee
authors.initials: MH
authors.lastname: Han
authors.affiliation: Department of Neurology, Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea Department of Neurology, The Armed Forces Capital Hospital, Gyeunggido, South Korea rohjk777@gmail.com neurorad63@gmail.com.
authors.forename: Jae-Kyu
authors.initials: JK
authors.lastname: Roh
mesh_terms: D016022:Case-Control Studies; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications / Q000175:diagnosis*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D020521:Stroke / Q000150:complications / Q000175:diagnosis*
keywords: Atherosclerosis; cerebral infarction; vessel wall magnetic resonance imaging