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. 2023 Mar 23:17:1160018.
doi: 10.3389/fnins.2023.1160018. eCollection 2023.

Characteristics of culprit intracranial plaque without substantial stenosis in ischemic stroke using three-dimensional high-resolution vessel wall magnetic resonance imaging

Xia Tian  1 , Zhang Shi  2 , Zhen Wang  1 , Bing Xu  1 , Wen-Jia Peng  1 , Xue-Feng Zhang  1 , Qi Liu  1 , Shi-Yue Chen  1 , Bing Tian  1 , Jian-Ping Lu  1 , Cheng-Wei Shao  1
Affiliations

Characteristics of culprit intracranial plaque without substantial stenosis in ischemic stroke using three-dimensional high-resolution vessel wall magnetic resonance imaging

Xia Tian et al. Front Neurosci. .

Abstract

Background and aims: We aim to analyze the difference in quantitative features between culprit and non-culprit intracranial plaque without substantial stenosis using three-dimensional high-resolution vessel wall MRI (3D hr-vw-MRI).

Methods: The patients with cerebral ischemic symptoms of the unilateral anterior circulation were recruited who had non-stenotic intracranial atherosclerosis (<50%) confirmed by computed tomographic angiographic (CTA) or magnetic resonance angiography (MRA). All patients underwent 3D hr-vw MRI within 1 month after symptom onset. 3D hr-vw-MRI characteristics, including wall thickness, plaque burden, enhancement ratio, plaque volume and intraplaque hemorrhage, and histogram features were analyzed based on T2-, precontrast T1-, and post-contrast T1-weighted images. Univariate and multivariate logistic regression analysis were used to identify key determinates differentiating culprit and non-culprit plaques and to calculate the odds ratios (ORs) with 95% confidence intervals (CIs).

Results: A total of 150 plaques were identified, of which 133 plaques (97 culprit and 36 non-culprit) were in the middle cerebral artery, three plaques (all culprit) were in the anterior cerebral artery (ACA) and 14 (11 culprit and three non-culprit) were in the internal carotid artery (ICA). Of all the quantitative parameters analyzed, plaque volume, maximum wall thickness, minimum wall thickness, plaque burden, enhancement ratio, coefficient of variation of the most stenotic site, enhancement ratio of whole culprit plaque in culprit plaques were significantly higher than those in non-culprit plaques. Multivariate logistic regression analysis found that plaque volume [OR, 1.527 (95% CI, 1.231-1.894); P < 0.001] and enhancement ratio of whole plaque [OR, 1.095 (95% CI, 1.021-1.175); P = 0.011] were significantly associated with culprit plaque. The combination of the two features obtained a better diagnostic efficacy for culprit plaque with sensitivity and specificity (0.910 and 0.897, respectively) than each of the two parameters alone.

Conclusion: 3D hr-vw MRI features of intracranial atherosclerotic plaques provided potential values over prediction of ischemic stroke patients with non-stenotic arteries. The plaque volume and enhancement ratio of whole plaque of stenosis site were found to be effective predictive parameters.

Keywords: 3D high-resolution magnetic resonance imaging; diagnostic efficacy; histogram features; intracranial non-stenotic atherosclerotic plaques; ischemic stroke.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
A 59 years-old man with acute ischemic stroke in the right basal ganglia. Time-of-flight (TOF)-magnetic resonance angiography (MRA) (A) demonstrated the stenosis located on the right middle cerebral artery (MCA). Diffusion weighted imaging (DWI) (B) showed a sheet acute infarcts in the right basal ganglia. High-resolution vessel wall MRI (hr-vw MRI) including T2-weighted image (C), pre-contrast T1-weighted image (D) and post-contrast T1-weighted image (E) visualized the plaque on the superior side of the right MCA. The plaque showed isointense to hyperintense on T2-weighted image (C) and pre-contrast T1-weighted image (D) and moderate enhancement on post-contrast T1-weighted image (E).
FIGURE 2
FIGURE 2
A 62 years-old man without any neuro symptom. Time-of-flight (TOF)-magnetic resonance angiography (MRA) (A) demonstrated a normal appearance. DWI (B) showed no acute infarct with the anterior circulation territory. High-resolution vessel wall MRI (hr-vw MRI) including T2-weighted image (C), pre-contrast T1-weighted image (D) and post-contrast T1-weighted image (E) visualized the plaque on the posterior and inferior side of the right middle cerebral artery (MCA). The plaque showed isointense on T2-weighted image (C) and pre-contrast T1-weighted image (D) and no enhancement on post-contrast T1-weighted image (E).
FIGURE 3
FIGURE 3
Receiver operating characteristic (ROC) curve on the basis of multivariable logistic regression to differentiate culprit from non-culprit plaques.
See this image and copyright information in PMC

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