Vessel wall MR imaging of intracranial atherosclerosis

Abstract

Intracranial atherosclerotic disease (ICAD) is one of the most common causes of ischemic stroke worldwide. Along with high recurrent stroke risk from ICAD, its association with cognitive decline and dementia leads to a substantial decrease in quality of life and a high economic burden. Atherosclerotic lesions can range from slight wall thickening with plaques that are angiographically occult to severely stenotic lesions. Recent advances in intracranial high resolution vessel wall MR (VW-MR) imaging have enabled imaging beyond the lumen to characterize the vessel wall and its pathology. This technique has opened new avenues of research for identifying vulnerable plaque in the setting of acute ischemic stroke as well as assessing ICAD burden and its associations with its sequela, such as dementia. We now understand more about the intracranial arterial wall, its ability to remodel with disease and how we can use VW-MR to identify angiographically occult lesions and assess medical treatment responses, for example, to statin therapy. Our growing understanding of ICAD with intracranial VW-MR imaging can profoundly impact diagnosis, therapy, and prognosis for ischemic stroke with the possibility of lesion-based risk models to tailor and personalize treatment. In this review, we discuss the advantages of intracranial VW-MR imaging for ICAD, the potential of bioimaging markers to identify vulnerable intracranial plaque, and future directions of artificial intelligence and its utility for lesion scoring and assessment.

The Utility of Vessel Wall Imaging in the Postulation of Acute Ischemic Stroke With Spontaneous Recanalization Pathophysiology

“… 4 In the field of AIS, a huge interest in intracranial atherosclerotic disease has meant a wider usage of VWI. 5 Our institution's stroke protocol 6 routinely incorporates VWI for the imaging of patients clinically presenting with acute stroke, with the scan parameters presented in Table 1 .…”

MR vessel wall imaging in cerebral bacterial and fungal infections

“…Other non-infective causes of vasculopathy in which vessel wall imaging plays an important diagnostic role include ICAD, primary CNS angiitis, RCVS, and Moyamoya disease [ 38 ]. ICAD can be differentiated from infective vasculitis on imaging by the presence of eccentric enhancing thickening which, on high-resolution T2WI, may also show presence of fibrofatty plaque [ 39 ]. Presence of positive remodeling is highly suggestive of ICAD as other stated etiologies cause stenosis of the involved arteries.…”

Vessel wall MR imaging of aortic arch, cervical carotid and intracranial arteries in patients with embolic stroke of undetermined source: A narrative review

“…Given the lack of readily available specimens for intracranial arteries, intracranial VW-MRI may be a non-invasive imaging modality enabling serial imaging to provide additional insight about intracranial atherosclerosis. Several features of intracranial atherosclerosis on VW-MRI have been described ( 59 , 60 ) and are detailed below.…”