Middle cerebral artery intraplaque hemorrhage: Prevalence and Clinical Relevance

Xu, Wei-Hai; Li, Mingli; Gao, Shan; Ni, Jun; Yao, Ming; Zhou, Lixin; Peng, Bin; Feng, Feng; Jin, Zhengyu; Cui, Liying

doi:10.1002/ana.22626

Cited by 160 publications

(154 citation statements)

References 26 publications

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“…Several previous intracranial VWI studies have related HST1 to IPH because of the fact that the major substance of IPH, methemoglobin, has a relatively short T1 relaxation time and, thus, appears hyperintense on T1‐weighted imaging 13, 16. In their work, HST1 was highly associated with ischemic symptoms 13, 16. In another study by Natori et al,18 HST1 was believed to indicate the presence of lipid components in addition to IPH.…”

Section: Discussionmentioning

confidence: 97%

“…The degree of vasa vasorum invading from the adventitia is increased in ruptured plaques compared with stable plaques, and microvascular incompetence is a plausible explanation for the occurrence of IPH 22, 25. Several previous intracranial VWI studies have related HST1 to IPH because of the fact that the major substance of IPH, methemoglobin, has a relatively short T1 relaxation time and, thus, appears hyperintense on T1‐weighted imaging 13, 16. In their work, HST1 was highly associated with ischemic symptoms 13, 16.…”

Section: Discussionmentioning

confidence: 99%

“…Xu et al13 reported HST1 in 19.6% of culprit lesions, and Yu et al16 reported HST1 in 53.3% of culprit lesions. Note that our definition of HST1 is based on whether plaque‐wall CR is >150%, whereas previous studies used different criteria.…”

Section: Discussionmentioning

confidence: 99%

“…The advent of 3‐dimensional VWI techniques in the past few years also makes it possible to simultaneously assess atherosclerotic plaques presenting in multiple arterial segments 11, 12. Using VWI, several plaque features have been intimately associated with symptomatic or asymptomatic lesions, such as high signal on T1‐weighted images (HST1), wall thickening pattern, and postcontrast enhancement 7, 13, 14, 15, 16, 17, 18. However, most of previous studies were limited to one feature only, a local arterial segment, or a cohort with heterogeneous time periods after symptom onset.…”

Section: Introductionmentioning

confidence: 99%

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Differential Features of Culprit Intracranial Atherosclerotic Lesions: A Whole‐Brain Vessel Wall Imaging Study in Patients With Acute Ischemic Stroke

Song

et al. 2018

JAHA

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BackgroundIntracranial atherosclerotic disease tends to affect multiple arterial segments. Using whole‐brain vessel wall imaging, we sought to study the differences in plaque features among various types of plaques in patients with a recent unilateral anterior circulation ischemic stroke.Methods and ResultsSixty‐one patients with unilateral anterior circulation ischemic stroke were referred to undergo whole‐brain vessel wall imaging (before and after contrast) within 1 month of symptom onset for intracranial atherosclerotic disease evaluations. Each plaque was classified as a culprit, probably culprit, or nonculprit lesion, according to its likelihood of causing the stroke. The associations between plaque features (thickening pattern, plaque‐wall contrast ratio, high signal on T1‐weighted images, plaque contrast enhancement ratio, enhancement grade, and enhancement pattern) and culprit lesions were estimated using mixed multivariable logistic regression after adjustment for maximum wall thickness. In 52 patients without motion corruption in whole‐brain vessel wall imaging, a total of 178 intracranial plaques in the anterior circulation were identified, including 52 culprit lesions (29.2%), 51 probably culprit lesions (28.7%), and 75 nonculprit lesions (42.1%). High signal on T1‐weighted images (adjusted odds ratio, 9.1; 95% confidence interval, 1.9–44.1; P=0.006), grade 2 (enhancement ratio of plaque ≥ enhancement ratio of pituitary) contrast enhancement (adjusted odds ratio, 17.4; 95% confidence interval, 1.8–164.9; P=0.013), and type 2 (≥50% cross‐sectional wall involvement) enhancement pattern (adjusted odds ratio, 10.1; 95% confidence interval, 1.3–82.2; P=0.030) were independently associated with culprit lesions.ConclusionsHigh signal on T1‐weighted images, grade 2 contrast enhancement, and type 2 enhancement pattern are associated with cerebrovascular ischemic events, which may provide valuable insights into risk stratification.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Differential Features of Culprit Intracranial Atherosclerotic Lesions: A Whole‐Brain Vessel Wall Imaging Study in Patients With Acute Ischemic Stroke

Song

et al. 2018

JAHA

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“…4 In recent years, a few studies have attempted to characterize intracranial atherosclerotic plaque composition by in vivo MR imaging. [5][6][7][8][9] Intracranial plaque imaging with MR imaging has identified high-risk plaque correlated with infarct territory and plaque associated with stroke recurrence. [10][11][12][13] However, these studies have mostly focused on plaque enhancement to ascertain plaque risk.…”

mentioning

confidence: 99%

Identification and Quantitative Assessment of Different Components of Intracranial Atherosclerotic Plaque by Ex Vivo 3T High-Resolution Multicontrast MRI

Jiang

Peng²,

Tian³

et al. 2017

AJNR Am J Neuroradiol

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Middle Cerebral Artery Plaque and Prediction of the Infarction Pattern

Kim¹,

Jung²,

Sohn³

et al. 2012

Arch Neurol

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Background: Intracranial atherosclerosis is associated with recurrent ischemic stroke. High-resolution magnetic resonance imaging can provide information about atheroma in vivo including plaque volume, composition, and activity. Objective: To evaluate atherosclerosis activity of the middle cerebral artery (MCA) by high-resolution magnetic resonance imaging and determine its relationship with infarction patterns. Design: Patients with MCA territory infarction or transient ischemic attack were enrolled and 3-T highresolution magnetic resonance imaging was performed in the relevant MCA. We analyzed the status of the intracranial atheroma and infarction pattern in the corresponding vascular territory. Intracranial atheroma was defined as vulnerable symptomatic plaque when it was accompanied by intraplaque heterogeneous signal intensity and plaque enhancement, and as a stable symptomatic plaque otherwise. Cerebral infarction pattern was defined as artery-to-artery embolic infarction when multiple lesions were present within the MCA territory. Setting: A tertiary referral center. Patients: A total of 34 patients were enrolled in the study; 14 patients had stable symptomatic plaque, 12 had vulnerable symptomatic plaque, and 8 had no plaque (normal group). Main Outcome Measures: Intracranial atheroma stability and infarction pattern. Results: High-resolution magnetic resonance images were acquired from 34 patients, which revealed the presence of stable symptomatic plaque in 14 patients and vulnerable symptomatic plaque in 12 patients. The patients with vulnerable symptomatic plaque more commonly demonstrated an artery-to-artery embolic infarction pattern than the patients with stable symptomatic plaque (P=.02). Conclusions: Vulnerable symptomatic plaque as determined by a high-resolution magnetic resonance imaging technique is associated with artery-to-artery embolic infarction. This novel imaging technique can provide information about intracranial atherosclerosis in vivo, which can predict the infarction pattern.

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Middle cerebral artery intraplaque hemorrhage: Prevalence and Clinical Relevance

Abstract: HST1 within MCA plaque on HR-MRI is associated with ipsilateral stroke. Our results provide new insight into the vascular biology of MCA atherosclerosis.

Cited by 160 publications

References 26 publications

Differential Features of Culprit Intracranial Atherosclerotic Lesions: A Whole‐Brain Vessel Wall Imaging Study in Patients With Acute Ischemic Stroke

Differential Features of Culprit Intracranial Atherosclerotic Lesions: A Whole‐Brain Vessel Wall Imaging Study in Patients With Acute Ischemic Stroke

Identification and Quantitative Assessment of Different Components of Intracranial Atherosclerotic Plaque by Ex Vivo 3T High-Resolution Multicontrast MRI

Middle Cerebral Artery Plaque and Prediction of the Infarction Pattern

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