Incremental value of plaque enhancement in predicting stroke recurrence in symptomatic intracranial atherosclerosis

Song, Xiaowei; Zhao, Xihai; Liebeskind, David S; Wang, Lixue; Xu, Wendeng; Xu, Yilan; Hou, D.; Zheng, Zhuozhao; Wu, Jian

doi:10.1007/s00234-020-02418-8

Cited by 31 publications

(31 citation statements)

References 23 publications

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“…31 In our study, patients with recurrent-stroke events had larger culprit plaques (measured by plaque volume) than those with first-time stroke events. No significant difference in other culprit plaque features such as the degree of stenosis, 4 plaque enhancement, 12,32 and plaque burden 13 was detected between the 2 groups, which was also reported by a recent similar study. 16 Plaque burden 13 and its progression with time 33 were reported to be associated with stroke recurrence.…”

Section: Discussionsupporting

confidence: 88%

“…5 Several recent studies also demonstrated that culprit plaque enhancement or enhancement ratio was related to recurrent stroke. 12,13,32 Our study quantitatively analyzed the culprit enhancement ratio but did not get a similar result. Instead of culprit plaque enhancement, our study indicated that the patients with recurrent-stroke events had more enhanced plaques, which might indicate more vulnerable plaques.…”

Section: Discussionmentioning

confidence: 68%

“…One hundred seventy-five patients (mean age, 59 [SD,12] years; 115 men) were included. Compared with the first-time stroke group (n ¼ 100), the recurrent-stroke group (n ¼ 75) had a larger culprit volume (P ¼ .006) and showed more intracranial plaques (P , .001) and more enhanced plaques (P ¼ .003).…”

Section: Resultsmentioning

confidence: 99%

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Large Culprit Plaque and More Intracranial Plaques Are Associated with Recurrent Stroke: A Case-Control Study Using Vessel Wall Imaging

Wang

Zhao

et al. 2022

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Intracranial atherosclerotic plaque features are potential factors associated with recurrent stroke, but previous studies only focused on a single lesion, and few studies investigated them with perfusion impairment. This study aimed to investigate the association among whole-brain plaque features, perfusion deficit, and stroke recurrence. MATERIALS AND METHODS:Patients with ischemic stroke due to intracranial atherosclerosis were retrospectively collected and categorized into first-time and recurrent-stroke groups. Patients underwent high-resolution vessel wall imaging and DSC-PWI. Intracranial plaque number, culprit plaque features (such as plaque volume/burden, degree of stenosis, enhancement ratio), and perfusion deficit variables were recorded. Logistic regression analyses were performed to determine the independent factors associated with recurrent stroke. RESULTS:One hundred seventy-five patients (mean age, 59 [SD,12] years; 115 men) were included. Compared with the first-time stroke group (n ¼ 100), the recurrent-stroke group (n ¼ 75) had a larger culprit volume (P ¼ .006) and showed more intracranial plaques (P , .001) and more enhanced plaques (P ¼ .003). After we adjusted for other factors, culprit plaque volume (OR, 1.16 per 10mm 3 increase; 95% CI, 1.03-1.30; P ¼ .015) and total plaque number (OR, 1.31; 95% CI, 1.13-1.52; P , .001) were independently associated with recurrent stroke. Combining these factors increased the area under the curve to 0.71. CONCLUSIONS:Large culprit plaque and more intracranial plaques were independently associated with recurrent stroke. Performing whole-brain vessel wall imaging may help identify patients with a higher risk of recurrent stroke.ABBREVIATIONS: HR-VWI ¼ high-resolution vessel wall imaging; IQR ¼ interquartile range I ntracranial atherosclerosis is the primary etiology of stroke in Asia, 1 and the risk of recurrent stroke in these patients is high even under aggressive medication. 2 Identification of the risk factors associated with recurrent stroke is essential for secondary stroke prevention.The degree of stenosis is a well-recognized predictor of recurrent stroke, and patients with .50% stenosis are recommended for more aggressive treatment. 3,4 However, vulnerable atherosclerotic plaques with ,50% stenosis can also lead to stroke events. 5,6 The development of high-resolution vessel wall imaging (HR-VWI) has enabled the visualization of vulnerable features (intraplaque hemorrhage, outward remodeling, neurovascularture) in vivo and has provided important insight into plaque vulnerability rather than the degree of stenosis alone. 7,8 The use of whole-brain HR-VWI also allows the evaluation of multiple lesions simultaneously. 9Previous HR-VWI studies of intracranial plaques focused on comparing patients with stroke and asymptomatic patients. 10,11 However, investigations of intracranial plaque features associated with recurrent stroke are still rare. A few studies found that plaque enhancement 12 and plaque burden 13 were associated with...

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 68%

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Large Culprit Plaque and More Intracranial Plaques Are Associated with Recurrent Stroke: A Case-Control Study Using Vessel Wall Imaging

Wang

Zhao

et al. 2022

AJNR Am J Neuroradiol

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“…Stroke recurrence in ICAS is related to various factors, such as plaque burden, plaque inflammation, infarction pattern, collateral status, etc. (Kim et al, 2016 ; Wabnitz et al, 2019 ; Song et al, 2020 ). Plaque burden and plaque enhancement are independent risk factors for stroke recurrence, and a greater degree of stenosis is associated with a higher risk of recurrence (Ran et al, 2020 ; Shi et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Radiomics Nomogram for Predicting Stroke Recurrence in Symptomatic Intracranial Atherosclerotic Stenosis

Tang

Gao

et al. 2022

Front. Neurosci.

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ObjectiveTo develop and validate a radiomics nomogram for predicting stroke recurrence in symptomatic intracranial atherosclerotic stenosis (SICAS).MethodsThe data of 156 patients with SICAS were obtained from the hospital database. Those with and without stroke recurrence were identified. The 156 patients were separated into a training cohort (n = 110) and a validation cohort (n = 46). Baseline clinical data were collected from our medical records, and plaque radiological features were extracted from vascular wall high-resolution imaging (VW-HRMRI). The imaging sequences included 3D-T1WI-VISTA, T2WI, and 3D-T1WI-VISTA-enhanced imaging. Least absolute shrinkage and selection operator (LASSO) analysis were used to select the radiomics features associated with stroke recurrence. Then, multiple logistic regression analysis of clinical risk factors, radiological features, and radiomics signatures were performed, and a predictive nomogram was constructed to predict the probability of stroke recurrence in SICAS. The performance of the nomogram was evaluated.ResultsDiabetes mellitus, plaque burden, and enhancement ratio were independent risk factors for stroke recurrence [odds ratio (OR) = 1.24, 95% confidence interval (CI): 1.04–3.79, p = 0.018; OR = 1.76, per 10% increase, 95% CI, 1.28–2.41, p < 0.001; and OR = 1.94, 95% CI: 1.27–3.09, p < 0.001]. Five features of 3D-T1WI-VISTA, six features of T2WI, and nine features of 3D-T1WI-VISTA-enhanced images were associated with stroke recurrence. The radiomics signature in 3D-T1WI-VISTA-enhanced images was superior to the radiomics signature of the other two sequences for predicting stroke recurrence in both the training cohort [area under the curve (AUC), 0.790, 95% CI: 0.669–0.894] and the validation cohort (AUC, 0.779, 95% CI: 0.620–0.853). The combination of clinical risk factors, radiological features, and radiomics signature had the best predictive value (AUC, 0.899, 95% CI: 0.844–0.936 in the training cohort; AUC, 0.803, 95% CI: 0.761–0.897 in the validation cohort). The C-index of the nomogram was 0.880 (95% CI: 0.805–0.934) and 0.817 (95% CI: 0.795–0.948), respectively, in the training and validation cohorts. The decision curve analysis further confirmed that the radiomics nomogram had good clinical applicability with a net benefit of 0.458.ConclusionThe radiomics features were helpful to predict stroke recurrence in patients with SICAS. The nomogram constructed by combining clinical high-risk factors, plaque radiological features, and radiomics features is a reliable tool for the individualized risk assessment of predicting the recurrence of SICAS stroke.

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“…It can not only accurately assess the degree of vascular luminal stenosis but also provide the size and composition information of intracranial atherosclerotic plaque (ICAP), including the detection of intra-plaque hemorrhage, plaque enhancement, vascular wall remodeling, and plaque distribution, etc., with extremely high repeatability [8,9] . In previous studies, ICAP features based on HR-VWI, including positive remodeling, intraplaque hemorrhage, and plaque enhancement, have been identi ed as markers of future stroke risks [10][11][12] . In this study, we focused on the relationship between plaque characteristics and stroke types in sICAS patients undergoing HR-VWI examination and followed up the patients to assess the differences in clinical risk factors and ICAP characteristics between patients with and without recurrent stroke, with the hope to identify novel intervention targets to develop more standardized secondary prevention strategies for ischemic stroke and TIA to reduce stroke recurrence.…”

Section: Introductionmentioning

confidence: 99%

Correlation of The Characteristics of Symptomatic Intracranial Atherosclerotic Plaques with Stroke Types and Risk of Stroke Recurrence

Ren¹,

Jiang²,

Zhu³

et al. 2021

Preprint

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Purpose To explore the relationship of the characteristics of symptomatic intracranial atherosclerotic plaques (ICAP) with stroke types and risk of stroke recurrence. Methods Patients with symptomatic intracranial atherosclerotic stenosis were prospectively enrolled. The vessel stenosis degree, plaque shape, plaque thickness, plaque burden, and plaque enhancement degree of all patients were assessed using high-resolution magnetic resonance imaging and statistically analyzed. Results In total, 206 patients (mean age (64 ± 12) years; 141 males) were included in this study, 154 had acute ischemic stroke (AIS), 52 had transient ischemic attack (TIA), 124 had anterior circulation ischemic symptom (ACIS), and 82 had posterior circulation ischemic symptom (PCIS). AIS patients showed higher diastolic blood pressure (t=-2.605, p = 0.011), total cholesterol (t=-2.470, p = 0.014), apolipoprotein b (z=-2.411, p = 0.016), apolipoprotein a/b (t=-2.865, p = 0.006), LDL (t=-2.424, p = 0.016), arteriosclerosis index (z=-2.256, p = 0.024), stenosis degree (t=-3.317, p < 0.001) but smaller luminal area at the plaque than TIA patients (t = 2.539, p = 0.013). In addition, 24 (13.6%) patients had stroke recurrence within 6 months. The proportion of patients with T1WI hyperintensity was higher in patients with recurrent stroke than in patients without recurrent stroke (RR = 2.592 (1.091, 6.58), χ²=4.892, p = 0.034). Patients with PCIS had greater plaque thickness (t=-4.205, p < 0.001) and remaining luminal area (z=-4.127, p < 0.001), significantly enhanced ICAP (χ²=9.681, p = 0.003), more positive remodeling (χ²=5.661, p = 0.015) and higher incidence of T1WI hyperintensity (χ²=16.472, p < 0.001) than patients with ACIS. The prevalence of diabetes (χ²=9.038, p = 0.004) in patients with PCIS is higher than that in patients with ACIS. Conclusions The degree of stenosis and the remaining luminal area of symptomatic ICAP are related to the type of stroke, and patients with T1WI hyperintense plaque had a higher risk of stroke recurrence within six months. Posterior circulation culprit plaque tends to have higher vulnerability, which may be related to metabolic factors secondary to diabetes.

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Incremental value of plaque enhancement in predicting stroke recurrence in symptomatic intracranial atherosclerosis

Cited by 31 publications

References 23 publications

Large Culprit Plaque and More Intracranial Plaques Are Associated with Recurrent Stroke: A Case-Control Study Using Vessel Wall Imaging

Large Culprit Plaque and More Intracranial Plaques Are Associated with Recurrent Stroke: A Case-Control Study Using Vessel Wall Imaging

Radiomics Nomogram for Predicting Stroke Recurrence in Symptomatic Intracranial Atherosclerotic Stenosis

Correlation of The Characteristics of Symptomatic Intracranial Atherosclerotic Plaques with Stroke Types and Risk of Stroke Recurrence

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