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. 2023 Dec 1;13(12):8383-8394.
doi: 10.21037/qims-23-611. Epub 2023 Oct 27.

Association between the fetal-type posterior cerebral artery and intracranial anterior and posterior circulating atherosclerotic plaques using multi-contrast magnetic resonance vessel wall imaging

Dingqi Liu  1 , Chenyang Zhao  1 , Deng-Ling Zhao  2 , Xiao-Hui Chen  2 , Dan Zhou #  1 , Cheng Li #  2
Affiliations

Association between the fetal-type posterior cerebral artery and intracranial anterior and posterior circulating atherosclerotic plaques using multi-contrast magnetic resonance vessel wall imaging

Dingqi Liu et al. Quant Imaging Med Surg. .

Abstract

Background: Intracranial atherosclerotic disease (ICAD) is one of the most common causes of ischemic stroke. The fetal-type posterior cerebral artery (FTP) affects intracranial collateral circulation, which is closely related to the occurrence and development of ICAD. Knowledge of the relationship between FTP and ICAD is important for developing treatment strategies for FTP patients diagnosed with atherosclerotic diseases. This study aims to quantitatively analyze the association between the FTP and intracranial atherosclerotic plaques using magnetic resonance vessel wall imaging (VW-MRI).

Methods: This retrospective study enrolled patients with recent cerebrovascular symptoms (stroke or transient ischemic attack <2 weeks) who were diagnosed with atherosclerotic plaque(s) by VW-MRI in one hospital from October 2018 to March 2022. They were classified into the FTP group and the non-FTP group. Plaque characteristics and vascular-related parameters in intracranial arteries were compared between the two groups. Univariate and multivariate logistic regressions were performed to determine the odds ratios (ORs) and corresponding 95% confidence intervals (CIs) of the plaque characteristics between the two groups.

Results: A total of 104 patients (mean age: 61.8±9.8 years, 57 males) were included for VW-MRI scan analysis. 40 (38.46%) and 64 (61.54%) were classified into the FTP and the non-FTP groups, respectively. The plaques of middle cerebral artery (MCA) in the FTP group were more likely to occur on the dorsal and superior walls of the lumen compared with the non-FTP group (37.50% vs. 17.19%, P=0.001). The remodeling index (RI) of MCA was statistically different between the two groups (1.071±0.267 vs. 0.886±0.235, P=0.007). No significant differences were found in vertebrobasilar artery (VBA) plaque distributions (17.50% vs. 9.38%, 10.00% vs. 12.50%, 20.00% vs. 17.19%, P>0.05) and characteristics between the two groups (RI: 1.095±0.355 vs. 0.978±0.251; eccentricity index: 0.539±1.622 vs. 0.550±0.171, P>0.05).

Conclusions: The plaques in the FTP group were more likely to occur on the dorsal and superior walls of the MCA, and the presentence of FTP was found to be significantly correlated with vascular remodeling of MCA atherosclerotic plaques. The relationship between the severity of intracranial atherosclerosis and the presence of FTP can provide valuable information for clinicians to intervene early and prevent the occurrence of stroke.

Keywords: Fetal-type posterior cerebral artery (FTP); atherosclerosis; magnetic resonance vessel wall imaging (VW-MRI); plaque.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-23-611/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Diagram of the remodeling index and eccentricity degree. Blue: vessel. Red: lumen. Yellow: culprit lesion. RI, remodeling index; WT, wall thickness.
Figure 2
Figure 2
Plaque location diagram. (A-C) The wall of MCA was divided into superior, inferior, ventral and dorsal walls. (D-F) The VBA vessel wall was divided into left, right, ventral and dorsal walls. MCA, middle cerebral artery; VBA, vertebrobasilar artery.
Figure 3
Figure 3
Flow chart of the participant selection.
Figure 4
Figure 4
Images of a 52-year-old male patient with FTP. (A) The TOF-MRA manifests stenosis of the M1 segment of the right MCA (arrowhead). The presence of FTP is shown (arrow). (B) The coronary T1-weighted VW-MRI demonstrates an enhanced plaque in the M1 segment of the right MCA (arrow). (C) The transverse T1-weighted VW-MRI indicates the presence of eccentric plaque (arrow). (D) Measurement at the most narrowed site in the T1-weighted VW-MRI: the vessel area was 5.61 mm2 (dotted white circle) and the lumen area was 1.12 mm2 (solid white circle). The remodeling index was calculated as follows: remodeling index = 1.17 (positive remodeling). FTP, fetal-type posterior cerebral artery; TOF, time of flight; MRA, magnetic resonance angiography; MCA, middle cerebral artery; VW-MRI, magnetic resonance vessel wall imaging.
Figure 5
Figure 5
Images of a 53-year-old male patient without FTP. (A) DWI indicates an acute ischemic stroke in the distribution of the right MCA. (B) The TOF-MRA manifests severe stenosis of the M1 segment of the right MCA (arrow). (C) The transverse T1-weighted VW-MRI demonstrates a plaque in the M1 segment of the right MCA (arrow). (D) Measurement at the most narrowed site in the T1-weighted VW-MRI: the vessel area was 7.43 mm2 (dotted white circle) and the lumen area was 0.4 mm2 (solid white circle). The remodeling index was calculated as follows: remodeling index =0.53 (negative remodeling). FTP, fetal-type posterior cerebral artery; DWI, diffusion-weighted imaging; MCA, middle cerebral artery; TOF, time of flight; MRA, magnetic resonance angiography; VW-MRI, magnetic resonance vessel wall imaging.
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