Magnetic Resonance Imaging of Plaque Morphology, Burden, and Distribution in Patients With Symptomatic Middle Cerebral Artery Stenosis.
Intracranial atherosclerosis is a major cause of ischemic stroke worldwide. Intracranial vessel wall imaging is an upcoming field of interest to assess intracranial atherosclerosis. In this study, we investigated total intracranial plaque burden in patients with symptomatic middle cerebral artery stenosis, assessed plaque morphological features, and compared features of symptomatic and asymptomatic lesions using a 3T vessel wall sequence.



Nineteen consecutive Chinese patients with ischemic stroke and transient ischemic attack (mean age: 67 years; 7 females) with a middle cerebral artery stenosis were scanned at 3T magnetic resonance imaging; the protocol included a time-of-flight magnetic resonance angiography and the T1-weighted volumetric isotropically reconstructed turbo spin echo acquisition sequence before and after (83%) contrast administration. Chi-square tests were used to assess associations between different plaque features. Statistical significance was set at P<0.05.



Vessel wall lesions were identified in 18 patients (95%), totaling 57 lesions in 494 segments (12% of segments). Lesions were located primarily in the anterior circulation (82%). Eccentric lesions were associated with a focal thickening pattern and concentric lesions with a diffuse thickening pattern (P<0.001). When differentiating between asymptomatic and symptomatic lesions, an association (P<0.05) was found between eccentricity and asymptomatic lesions, but not for enhancement or a specific thickening pattern. Symptomatic lesions did not have any specific morphological features.



Our results lead to a 2-fold conclusion: (1) The classification system of both thickening pattern and distribution of the lesion can be simplified by using distribution pattern only and (2) differentiation between symptomatic and asymptomatic atherosclerotic lesions was possible using intracranial vessel wall imaging.
From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Nikki
N
Dieleman
From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Wenjie
W
Yang
From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Jill M
JM
Abrigo
From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Winnie Chiu Wing
WC
Chu
From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Anja G
AG
van der Kolk
From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Jeroen C W
JC
Siero
From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Ka Sing
KS
Wong
From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Jeroen
J
Hendrikse
From the Department of Radiology, University Medical Center Utrecht, The Netherlands (N.D., A.G.v.d.K., J.C.W.S., J.H.); and Department of Medicine (W.Y., K.S.W., X.Y.C.) and Department of Imaging and Interventional Radiology (J.M.A., W.C.W.C.), Chinese University of Hong Kong, Shatin, Hong Kong SAR, China. fionachen@cuhk.edu.hk.
Xiang Yan
XY
Chen
D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging*; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging*
atherosclerosis; brain; magnetic resonance imaging; stroke