Assessment of the degree of arterial stenosis in intracranial atherosclerosis using 3D high-resolution MRI: comparison with time-of-flight MRA, contrast-enhanced MRA, and DSA

Zhao, Dongyan; Li, R.-Y.; Li, C.; Chen, X.-H.; Yu, Junnan; Zhang, Y.; Ju, Shenghong

doi:10.1016/j.crad.2022.08.132

Cited by 7 publications

(4 citation statements)

References 31 publications

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“…Compared to DSA, HR VWI has been repeatedly demonstrated to be a reliable, non-invasive method to evaluate intracranial arterial stenosis and collateral circulation. However, previous findings have illustrated that HR VWI shows a strong correlation with DSA ( 23 , 24 ).…”

Section: Discussionmentioning

confidence: 77%

Burden of dilated perivascular spaces in patients with moyamoya disease and moyamoya syndrome is related to middle cerebral artery stenosis

et al. 2023

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Background and objectiveThe correlation between intracranial large artery disease and cerebral small vessel disease (CSVD) has become a noteworthy issue. Dilated perivascular spaces (dPVS) are an important marker of CSVD, of which cerebral atrophy has been regarded as one of the pathological mechanisms. DPVS has been found to be associated with vascular stenosis in patients with moyamoya disease (MMD), but the underlying mechanism remains unclear. The purpose of our study was to explore the correlation between the middle cerebral artery (MCA) stenosis and dPVS in the centrum semiovale (CSO-dPVS) in patients with MMD/moyamoya syndrome (MMS) and to determine whether brain atrophy plays a mediating role in this relationship.MethodsA total of 177 patients were enrolled in a single-center MMD/MMS cohort. Images of their 354 cerebral hemispheres were divided into three groups according to dPVS burden: mild (dPVS 0–10), moderate (dPVS 11–20), and severe (dPVS > 20). The correlations among cerebral hemisphere volume, MCA stenosis, and CSO-dPVS were analyzed, adjusting for the confounding factors of age, gender, and hypertension.ResultsAfter adjustment for age, gender, and hypertension, the degree of MCA stenosis was independently and positively associated with ipsilateral CSO-dPVS burden (standardized coefficient: β = 0.247, P < 0.001). A stratified analysis found that the subgroup with a severe CSO-dPVS burden exhibited a significantly higher risk of severe stenosis of the MCA [p < 0.001, OR = 6.258, 95% CI (2.347, 16.685)]. No significant correlation between CSO-dPVS and ipsilateral hemisphere volume was found (p = 0.055).ConclusionIn our MMD/MMS cohort, there was a clear correlation between MCA stenosis and CSO-dPVS burden, which may be a direct effect of large vessel stenosis, without a mediating role of brain atrophy.

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Section: Discussionmentioning

confidence: 77%

Burden of dilated perivascular spaces in patients with moyamoya disease and moyamoya syndrome is related to middle cerebral artery stenosis

et al. 2023

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“…In highly stenotic lesions, there is an overestimation of stenosis in TOF due to loss of local blood flow signal intensity and the dephasing effect causing magnetization artifacts. 2 Contrast enhanced MRA has shown better sensitivity in determining stenosis in higher grade lesions. HR-VWI with contrast and post-processing analysis may lend more insight into inflammation, intraplaque rupture, and differentiation of other causes of intracranial artery narrowing such as arterial dissection, moyamoya, vasculitis, and other pathologies.…”

Section: Diagnosis Of Icadmentioning

confidence: 99%

Intracranial atherosclerosis update for neurointerventionalists

Alexander

2023

J NeuroIntervent Surg

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The management of intracranial atherosclerotic disease (ICAD) has been evolving with advanced imaging, refinements of best medical treatment, and the development of endovascular options. There has been a significant increase in the use of endovascular therapy for symptomatic ICAD in the USA over the past 6 years. The rationale for this review is to update neurointerventionalists in these areas so that evidence-based decisions can be considered when counseling potential patients regarding their risks, benefits, and potential complications. The landmark SAMMPRIS trial demonstrated superiority of aggressive medical management (AMM) over intracranial stenting as an initial treatment. However, the risk of disabling or fatal stroke remains high in patients presenting with stroke treated with AMM. Recent studies showed a significantly lower rate of periprocedural complications from intracranial stenting. Patients who have failed medical treatment may therefore benefit from intracranial stenting, particularly in those with hemodynamic compromise and large vessel embolic stroke. Drug coated angioplasty balloons and drug eluting stents may potentially reduce the risk of in-stent re-stenosis. Large vessel occlusion (LVO) due to underlying ICAD is seen in a subset of thrombectomy-eligible patients. The use of stenting as a rescue therapy in LVO thrombectomy has also shown promising early results.

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“…It's worth noting that while these characteristics are readily discernible within the carotid system, the differentiation becomes notably more challenging within the narrower confines of intracranial arteries. Additionally, in the context of carotid plaques, researchers observed a preferential enhancement of the fibrous cap through gadolinium-based contrast agent (83). In evaluating intracranial vascular atherosclerosis, HR-MRI emerges as a precise tool for quantifying intracranial atherosclerotic stenosis, particularly in cases of moderate to severe stenosis.…”

Section: Hr-mrimentioning

confidence: 99%

Characteristics and evaluation of atherosclerotic plaques: an overview of state-of-the-art techniques

He,

Luo,

et al. 2023

Front. Neurol.

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Atherosclerosis is an important cause of cerebrovascular and cardiovascular disease (CVD). Lipid infiltration, inflammation, and altered vascular stress are the critical mechanisms that cause atherosclerotic plaque formation. The hallmarks of the progression of atherosclerosis include plaque ulceration, rupture, neovascularization, and intraplaque hemorrhage, all of which are closely associated with the occurrence of CVD. Assessing the severity of atherosclerosis and plaque vulnerability is crucial for the prevention and treatment of CVD. Integrating imaging techniques for evaluating the characteristics of atherosclerotic plaques with computer simulations yields insights into plaque inflammation levels, spatial morphology, and intravascular stress distribution, resulting in a more realistic and accurate estimation of plaque state. Here, we review the characteristics and advancing techniques used to analyze intracranial and extracranial atherosclerotic plaques to provide a comprehensive understanding of atheroma.

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Assessment of the degree of arterial stenosis in intracranial atherosclerosis using 3D high-resolution MRI: comparison with time-of-flight MRA, contrast-enhanced MRA, and DSA

Cited by 7 publications

References 31 publications

Burden of dilated perivascular spaces in patients with moyamoya disease and moyamoya syndrome is related to middle cerebral artery stenosis

Burden of dilated perivascular spaces in patients with moyamoya disease and moyamoya syndrome is related to middle cerebral artery stenosis

Intracranial atherosclerosis update for neurointerventionalists

Characteristics and evaluation of atherosclerotic plaques: an overview of state-of-the-art techniques

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