Utility of intracranial high-resolution vessel wall magnetic resonance imaging in differentiating intracranial vasculopathic diseases causing ischemic stroke

Kesav, Praveen; Krishnavadana, Balamurali; Kesavadas, Chandrasekharan; Sreedharan, Sapna Erat; Rajendran, Adhithyan; Sukumaran, Sajith; Sylaja, PN

doi:10.1007/s00234-019-02157-5

Cited by 30 publications

(21 citation statements)

References 27 publications

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“…High-resolution intracranial vessel wall imaging (HRVWI) has recently been developed as a reliable tool to distinguish MMD from other intracranial vessel pathologies. 2,4,5 There are few studies that describe concentric vessel wall enhancement that involves the distal ICA and proximal MCA in patients with symptomatic and patients with asymptomatic MMD. 1,4 On the symptomatic side, concentric enhancement was observed in 82.1% of distal ICAs and 94.1% of proximal MCAs.…”

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confidence: 99%

Vessel Wall Thickening and Enhancement in High-Resolution Intracranial Vessel Wall Imaging: A Predictor of Future Ischemic Events in Moyamoya Disease

Kathuveetil¹,

Sylaja²,

Senthilvelan

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Very few data are available with regard to high-resolution intracranial vessel wall imaging characteristics of Moyamoya disease and their relation to ischemic stroke risk. We investigated the high resolution imaging characteristics of MMD and its correlation with recent ischemic events. MATERIALS AND METHODS:Patients with Moyamoya disease confirmed by DSA, including patients after revascularization, were enrolled. All the patients underwent high-resolution intracranial vessel wall imaging. Vessel wall thickening, enhancement, and the remodeling index of the bilateral distal ICA and proximal MCA were noted. The patients were followed up at 3 months and 6 months after high-resolution intracranial vessel wall imaging and the association of ischemic events with imaging characteristics was assessed. RESULTS:Twenty-nine patients with Moyamoya disease were enrolled. The median age at symptom onset was 12 years (range, 1-51 years). A total of 166 steno-occlusive lesions were detected by high-resolution intracranial vessel wall imaging. Eleven lesions with concentric wall thickening (6.6%) were noted in 9 patients. Ten concentric contrast-enhancing lesions were observed in 8 patients, of which 3 patients (4 lesions) showed grade II enhancement. The presence of contrast enhancement (P 4 .01) and wall thickening (P # .001) showed a statistically significant association with ischemic events within 3 months before and after the vessel wall imaging. Grade II enhancement showed a statistically significant (P 4 .02) association with ischemic events within 4 weeks of high-resolution intracranial vessel wall imaging. The mean 6 standard deviation outer diameter of the distal ICA (right, À3.3 6 0.68 mm; left, 3.4 6 0.60 mm) and the remodeling index (right, 0.71 6 0.13; left, 0.69 6 0.13) were lower in Moyamoya disease. CONCLUSIONS:High-resolution intracranial vessel wall imaging characteristics of concentric wall thickening and enhancement are relatively rare in our cohort of patients with Moyamoya disease. The presence of wall thickening and enhancement may predict future ischemic events in patients with Moyamoya disease. ABBREVIATIONS: ACA 4 anterior cerebral artery; HRVWI 4 high-resolution intracranial vessel wall imaging; MMD 4 Moyamoya disease; PCA 4 posterior cerebral artery; SD 4 standard deviation Indicates open access to non-subscribers at www.ajnr.org http://dx.

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confidence: 99%

Vessel Wall Thickening and Enhancement in High-Resolution Intracranial Vessel Wall Imaging: A Predictor of Future Ischemic Events in Moyamoya Disease

Kathuveetil¹,

Sylaja²,

Senthilvelan

et al. 2020

AJNR Am J Neuroradiol

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“…It would be most interesting to know whether in a prospective design, if a change in therapeutic management would follow, indicating confidence in the diagnostic interpretation or in a retrospective study including diagnostic follow-up information to assess diagnostic accuracy. In a slightly different study design, Kesav et al 4 also assessed the potential impact of VW-MR imaging by measuring the reclassification of stroke etiologies with the addition of VW-MR imaging. Kesav et al also suggest that VW-MR imaging impacts the diagnostic evaluation with diagnostic etiology reclassification in cases originally classified as "undetermined" etiologies and large (intracranial) artery atherosclerosis.…”

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Impact of Vessel Wall MR Imaging in the Work-Up for Ischemic Stroke

Song

2019

AJNR Am J Neuroradiol

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“…Very few studies have looked into the application of HRVWI with advanced sequences (3D-VRFA T1 and T2W CUBE) and utilizing the remodeling index exclusively in PACNS. [ 10 11 18 19 ] Here, we described the salient abnormalities seen in HRVWI in 20 patients with PACNS. The commonly observed vessel wall appearances were as follows: (i) concentric wall thickening; (ii) concentric enhancement with Grade I–II hyperintensity, and (iii) negative remodeling.…”

Section: Discussionmentioning

confidence: 99%

“…[ 8 9 ] Additionally, very few studies have explored the clinical utility of HRVWI in PACNS. [ 10 11 ] The aim of this study was a descriptive analysis of the vessel wall imaging features in PACNS.…”

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confidence: 99%

High-Resolution Vessel Wall Imaging in Primary Angiitis of Central Nervous System

Sundaram

Kumar

Sharma

et al. 2021

Annals of Indian Academy of Neurology

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Background: High-resolution vessel wall imaging (HRVWI) can aid in differentiating the various intracranial vasculopathies, but has been sparingly used in the diagnosis of primary angiitis of central nervous system (PACNS). This study is aimed to describe the vessel wall imaging characteristics of PACNS. Materials and Methods: Patients with confirmed diagnosis of PACNS according to the Calabrese and Mallek criteria who had abnormal HRVWI were included in this retrospective descriptive study. Magnetic resonance image of brain, conventional four-vessel cerebral digital subtraction angiogram, and HRVWI were read by a neuroradiologist. The vessel wall parameters assessed were T1W and T2W appearances, pattern of wall thickening and contrast enhancement, and remodeling index. Results: HRVWI done in 21 patients with PACNS yielded abnormality in 20 (95.2%) who were included in the analysis. The mean age at presentation was 42.55 ± 9.48 years and 14 (70%) were males. The median number of vessels involved were four (range 2–12). The commonest vessels affected were proximal middle cerebral artery (70%) and internal carotid artery (55%). Vessel wall thickening was concentric, eccentric, and absent in 12 (60%), 1 (5%), and 7 (35%) patients, respectively. Vessel wall enhancement was diffuse in 17 (85%), eccentric in 1 (5%), and absent in 2 (10%) patients. One patient had T2W hyperintense stenotic lesion. Remodeling index was negative in 11 (55%) patients. Conclusion: Distinctive vessel wall appearances were observed by HRVWI in PACNS, concentric vessel wall thickening and enhancement being more frequent. Hence, HRVWI can be considered as an additional noninvasive imaging modality in the diagnosis of PACNS.

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Utility of intracranial high-resolution vessel wall magnetic resonance imaging in differentiating intracranial vasculopathic diseases causing ischemic stroke

Cited by 30 publications

References 27 publications

Vessel Wall Thickening and Enhancement in High-Resolution Intracranial Vessel Wall Imaging: A Predictor of Future Ischemic Events in Moyamoya Disease

Vessel Wall Thickening and Enhancement in High-Resolution Intracranial Vessel Wall Imaging: A Predictor of Future Ischemic Events in Moyamoya Disease

Impact of Vessel Wall MR Imaging in the Work-Up for Ischemic Stroke

High-Resolution Vessel Wall Imaging in Primary Angiitis of Central Nervous System

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