Integrated head and neck imaging of symptomatic patients with stroke using simultaneous non-contrast cardiovascular magnetic resonance angiography and intraplaque hemorrhage imaging as compared with digital subtraction angiography

Abstract

Background Both stenosis rate and intraplaque hemorrhage (IPH) are important predictors of stroke risk. Simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP) cardiovascular magnetic resonance (CMR) imaging can detect both stenosis rate and IPH. We aimed to evaluate consistency between SNAP and digital subtraction angiography (DSA) to assess symptomatic patients with stroke and explore the performance of SNAP to identify IPH and the clinical factors associated with IPH. Methods Eighty-one symptomatic patients with stroke, admitted to Wuhan Union Hospital who underwent CMR high-resolution vessel wall imaging (HR-VWI) and SNAP, were retrospectively identified. For patients who received interventional therapy, the imaging functions of SNAP and HR-VWI were compared with DSA. The diameters of the intracranial and carotid vessels were measured, and stenotic vessels were identified. The consistency of SNAP and HR-VWI in identifying IPH was also examined, and the correlations between IPH and clinical factors were analyzed. Results SNAP was more consistent with DSA than HR-VWI in measuring vascular stenosis (intraclass correlation coefficient [ICC]SNAP-DSA = 0.917, ICC HR-VWI-DSA = 0.878). Regarding the diameter measurements of each intracranial and carotid vessel segment, SNAP was superior or similar to HR-VWI, and both were consistent with DSA in the measurement of major intracranial vascular segments. HR-VWI and SNAP exhibited acceptable agreement in identifying IPH (Kappa = 0.839, 95% confidence interval [CI]: 0.704–0.974). Patients who underwent interventional therapy had a higher plaque burden (P < 0.001). Patients with IPH had lower levels of high-density lipoprotein cholesterol (HDL) (P = 0.038) and higher levels of blood glucose (P = 0.007) and cystatin C (P = 0.040). Conclusions CMR SNAP is consistent with DSA in measuring vessel diameters and identifying atherosclerosis stenosis in each intracranial and carotid vessel segment. SNAP is also a potential alternative to HR-VWI in identifying stenosis and IPH.

Detectability of intracranial vessel wall atherosclerosis using black-blood spectral CT: a phantom and clinical study

“…All sequences were performed at identical scan planes and with the same spatial resolution covering the cervicocerebral artery. All imaging parameters for both reference and 3D protocols have been previously described [ 14 ]. The 3D multicontrast protocol can achieve isotropic 0.8 mm × 0.8 mm × 0.8 mm = 0.512 mm 3 resolution to cover the major intracranial and entire carotid arteries within 30–40 min.…”

High-resolution magnetic resonance vessel wall imaging in ischemic stroke and carotid artery atherosclerotic stenosis: A review

“…HR-VWI has been confirmed to be a novel and practical clinical tool for diagnosing ischemic stroke [ 36 , 37 , 94 , 104 , 105 ]. This technique can effectively identify unstable plaques and predict ischemic stroke occurrence [ 94 , 105 ].…”

“…In conclusion, HR-VWI has a key role in understanding stroke pathophysiology and etiology, identifying high-risk individuals, and guiding personalized treatment. It improves our knowledge of the relationship between vascular wall abnormalities and stroke and ultimately results in better stroke prevention and management [ 94 , 104 , 105 , 112 ]. HR-VWI thus holds promising prospects for its application in ischemic stroke diagnosis and prevention.…”

Editorial: Brain metabolic imaging by magnetic resonance imaging and spectroscopy: methods and clinical applications

“…In a hybrid setup, the 18 F-FDG PET was able to evaluate the inflammatory condition in the plaque, depending on the 18 F-FDG uptake by the macrophages, and the high-resolution MRI was able to provide morphological information on the plaque content. It would be very interesting if some more recent and more advanced MRI techniques, such as the simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP) imaging (Jia et al, 2022), could be included in the study. Nevertheless, this work has exemplified the coordinated implementation of MRI and nuclear medicine, which is probably necessary to account for the multimodal nature of the complicated and systemic diseases (Hricak et al, 2021).…”