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Review
. 2023 May;61(3):491-500.
doi: 10.1016/j.rcl.2023.01.006. Epub 2023 Feb 20.

Vessel Wall Imaging in Cryptogenic Stroke

Bhagya Sannananja  1 , Chengcheng Zhu  2 , Mahmud Mossa-Basha  3
Affiliations
Review

Vessel Wall Imaging in Cryptogenic Stroke

Bhagya Sannananja et al. Radiol Clin North Am. 2023 May.

Abstract

Cryptogenic strokes are symptomatic cerebral ischemic infarcts without a clear etiology identified following standard diagnostic evaluation and currently account for 10% to 40% of stroke cases. Continued research is needed to identify and bridge gaps in knowledge of this stroke grouping. Vessel wall imaging has increasingly shown its utility in the diagnosis and characterization of various vasculopathies. Initial promising evidence suggests rational use of vessel wall imaging in stroke workup may unravel pathologies that otherwise would have been occult and further improve our understanding of underlying disease processes that can translate into improved patient outcomes and secondary stroke prevention.

Keywords: Cryptogenic stroke; Embolic stroke of undetermined source; Stroke; Vessel wall imaging.

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Figures

Fig. 1.
Fig. 1.
Stroke with non-stenotic plaque. Axial TOF-MRA (A) shows non-stenotic carotid plaque, with outer wall thickening (short arrow). Axial T1-weighted VWI pre-contrast (B) shows outward remodeling plaque (short arrow) with vague internal T1 hyperintensity, whereas on axial T1-MPRAGE (C), plaque hyperintensity (short arrow) is more defined, more clearly representing intraplaque hemorrhage.
Fig. 2.
Fig. 2.
Non-stenotic dissection. Axial T1-weighted (A) and T2-weighted (B) VWI show crescentic T1 and T2 hyperintense intramural blood, representing dissection.
Fig. 3.
Fig. 3.
Stroke with non-stenotic plaque. On axial DWI (A), left MCA territory acute ischemic infarcts are present. Axial TOF-MRA of the brain (B) shows no evidence of left MCA stenosis. Sagittal (C) and axial (E) post-contrast and axial (D) pre-contrast T1-weighted VWI show an eccentric, non-stenotic, outwardly remodeling, and enhancing atherosclerotic plaque along the anterior wall of the distal left M1 MCA (short arrow).
Fig. 4.
Fig. 4.
Non-stenotic vasculitis. 3D-MIP TOF-MRA (A) and axial source TOF-MRA (B) covering the ACA show no luminal stenosis. Axial T1-weighted post-contrast VWI (C) shows eccentric diffusely enhancing lesion involving the pericallosal anterior cerebral artery branch, with blurry margins (short arrow). Coronal T1-weighted post-contrast image (D) shows circumferential enhancement with blurry margins involving the pericallosal arteries on both sides (short arrow). Biopsy revealed primary angiitis of the CNS.
Fig. 5.
Fig. 5.
Small artery vasculitis. 3D-MIP TOF-MRA (A) shows no arterial stenosis. Axial T1-weighted post-contrast image (B) at the basal ganglia shows multiple punctate foci of enhancement (short arrows) along perivascular spaces. Axial post-contrast T1-weighted VWI (C) over the pons shows curvilinear enhancement, representing perforator arteries and perivascular soft tissues enhancement (arrowheads). Biopsy revealed granulomatous angiitis.
See this image and copyright information in PMC

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