Intracranial artery atherosclerosis and lumen dilation in cerebral small-vessel diseases: a high-resolution MRI Study

Abstract

Background and aims: Using high-resolution magnetic resonance imaging (HR-MRI), we aimed to investigate the abnormalities of intracranial artery in relation to cerebral small-vessel diseases (SVD)-related ischemic stroke and white matter lesions (WMLs).

Methods: Routine cranial MRI and HR-MRI were performed on consecutive patients with a SVD-related acute deep brain infarct (DBI) in the territory of middle cerebral artery (MCA), patients with SVD-related WMLs, and age-matched controls. The presence and distribution of MCA plaque and the area of MCA lumen and wall were comparatively analyzed among the groups.

Results: A total of 2340 image slices of 260 vessels in 130 subjects (57 with an acute DBI, 28 with WMLs, and 45 control subjects) were analyzed. In the patients with a DBI, eccentric plaques were identified in 26 vessels ipsilateral and 24 vessels contralateral to the ischemic lesions. Superior-wall plaques of MCA were observed more frequently ipsilateral than contralateral to the infarcts (69.2% vs. 37.5%, P = 0.025). Compared to the controls, larger outer-wall boundary area (P ≤ 0.017) and wall area (P < 0.001) were observed in the patients, while larger lumen was only observed in the WMLs group (P < 0.001).

Conclusions: Middle cerebral artery superior-wall plaques are associated with acute DBIs, while MCA lumen dilation is associated with WMLs.

Keywords: Atheroma; Lacunar infarct; Magnetic resonance imaging; Middle cerebral artery; White matter lesions.

Figure 1

A patient had an infarct in the right periventricular region on diffusion‐weighted images (arrow, A). Magnetic resonance angiography showed no stenosis (B). On high‐resolution T2‐weighted imaging of right middle cerebral artery (arrow, C), no plaque was seen. For comparison, in another patient with a similar infarct (arrow, D) and normal magnetic resonance angiography findings (E), a superior‐wall plaque was observed (arrow, F).