Intracranial vessel wall lesions on 7T MRI and MRI features of cerebral small vessel disease: The SMART-MR study

Abstract

The etiology of cerebral small vessel disease (CSVD) is the subject of ongoing research. Although intracranial atherosclerosis (ICAS) has been proposed as a possible cause, studies on their relationship remain sparse. We used 7 T vessel wall magnetic resonance imaging (MRI) to study the association between intracranial vessel wall lesions—a neuroimaging marker of ICAS—and MRI features of CSVD. Within the SMART-MR study, cross-sectional analyses were performed in 130 patients (68 ± 9 years; 88% male). ICAS burden—defined as the number of vessel wall lesions—was determined on 7 T vessel wall MRI. CSVD features were determined on 1.5 T and 7 T MRI. Associations between ICAS burden and CSVD features were estimated with linear or modified Poisson regression, adjusted for age, sex, vascular risk factors, and medication use. In 125 patients, ≥1 vessel wall lesions were found (mean 8.5 ± 5.7 lesions). ICAS burden (per + 1 SD) was associated with presence of large subcortical and/or cortical infarcts (RR = 1.65; 95%CI: 1.12–2.43), lacunes (RR = 1.45; 95% CI: 1.14–1.86), cortical microinfarcts (RR = 1.48; 95%CI: 1.13–1.94), and total white matter hyperintensity volume ( b = 0.24; 95%CI: 0.02–0.46). Concluding, patients with a higher ICAS burden had more CSVD features, although no evidence of co-location was observed. Further longitudinal studies are required to determine if ICAS precedes development of CSVD.

Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know

“…Intracranial atherosclerosis has been downplayed as a contributor to SVD, likely because traditional vascular sequences (ie, MRA) can only assess luminal stenosis in large arteries. 73 Vessel wall imaging has revealed that intracranial atherosclerosis burden, which is dependent on features of both the lumen and the vessel wall, is related to cortical and subcortical infarcts, microinfarcts, and WMH. 73 Several other pathologies can be captured by vessel wall imaging and may elucidate the etiology of SVD, such as atherosclerotic plaque, large-vessel vasculitis, and discrimination of reversible cerebral vasoconstriction syndrome.…”

“…73 Vessel wall imaging has revealed that intracranial atherosclerosis burden, which is dependent on features of both the lumen and the vessel wall, is related to cortical and subcortical infarcts, microinfarcts, and WMH. 73 Several other pathologies can be captured by vessel wall imaging and may elucidate the etiology of SVD, such as atherosclerotic plaque, large-vessel vasculitis, and discrimination of reversible cerebral vasoconstriction syndrome. 70 Artificial Intelligence Advances in SVD While identifying the presence of at least 1 lacune or cerebral microbleed is straightforward in most situations, visual grading of WMH and PVS poses a unique challenge because the rating scales are inherently subjective, with poor agreement among neuroradiologists.…”

Impaired dynamic cerebral autoregulation is associated with the severity of neuroimaging features of cerebral small vessel disease

“… 25 , 26 Until recently, the specific pathological mechanisms underlying CSVD still remained largely unknown, in part because of the lack of effective methods that can technically visualize or image small vessels in vivo. 4 , 25 Although the advances in neuroimaging have provided novel information in CSVD including detailed evaluation of the vessel wall, atherosclerotic plaques within intracranial arteries, 27 , 28 white matter integrity, WMH shape, and the fraction of free water in the drainage area, 29 , 30 , 31 there have been few researches investigating the dynamic vasculature's function of small vessels, such as dCA.…”

Stroke Side Identification in the Brain by Retinal Image Analysis

“…Hence, identifying the stroke side was one of the critical roles. The current imaging tool and the gold standard would be MRI [24][25][26], but since it is an expensive and a time-consuming procedure, its use clinically and in research is limited. Other imaging tests, such as CT and angiography, help in identifying the location hours after strokes, but one of the problems using CT is the high radiation dose.…”