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Utility of intracranial high-resolution vessel wall magnetic resonance imaging in differentiating intracranial vasculopathic diseases causing ischemic stroke

  • Praveen Kesav
  • Balamurali Krishnavadana
  • Chandrasekharan Kesavadas
  • Sapna E. Sreedharan
  • Adhithyan Rajendran
  • Sajith Sukumaran
  • P. N. SylajaEmail author
Diagnostic Neuroradiology
  • 46 Downloads

Abstract

Purpose

High-resolution vessel wall imaging (HRVWI) by MRI is a novel noninvasive imaging tool which provides direct information regarding vessel wall pathologies. The utility of HRVWI in differentiating various intracranial vasculopathies among ischemic stroke is still evolving.

Methods

Consecutive ischemic stroke/TIA patients within 2 weeks of symptom onset between January 2016 to December 2017, with symptomatic vessel stenosis of 50% or more/occlusion on baseline luminal imaging studies were recruited into the study. Stroke subtypes were classified as per TOAST classification initially on the basis of luminal imaging findings alone and subsequently after incorporation of HRVWI findings as well.

Results

Forty-nine subjects were recruited into the study. The median age of the population was 42 years (range 11 to 75) with 69% being males. Incorporation of HRVWI findings classified 38.8% subjects into intracranial atherosclerotic disease (ICAD), 32.6% as stroke of other determined aetiology (ODE) (inflammatory vasculopathy [IVas] being the major subgroup [81.2%]) and 28.6% into stroke of undetermined aetiology (UE). HRVWI enabled a diagnostic reclassification in an additional 47.3% among the baseline UE category as against luminal imaging findings alone. ICAD was likelier to have eccentric vessel wall thickening, eccentric vessel wall enhancement and T2 juxtaluminal hyperintensity with surrounding hypointensity (P < 0.001), while IVas were more likely to exhibit concentric vessel wall thickening with homogenous enhancement (P < 0.001).

Conclusion

HRVWI is a useful noninvasive adjunctive tool in the diagnostic evaluation of intracranial vasculopathies, with maximum benefit in ICAD and IVas subtypes.

Keywords

MR vessel wall imaging Intracranial atherosclerotic disease Inflammatory vasculopathies 

Abbreviations

CTA

Computed tomography angiography

MRA

Magnetic resonance angiography

DSA

Digital subtraction angiography

PACNS

Primary angiitis of central nervous system

HRVWI

High-resolution vessel wall magnetic resonance imaging

ICAD

Intracranial atherosclerotic disease

RCVS

Reversible cerebral vasoconstriction syndrome

TOAST

Trial of Org 10172 in Acute Stroke Treatment

ODE

Stroke of other determined aetiology

UE

Stroke of undetermined aetiology

IVas

Inflammatory vasculopathy

MMD

Moyamoya disease

Notes

Compliance with ethical standards

Funding

No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Comprehensive Stroke Care Program, Department of NeurologySree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST)ThiruvananthapuramIndia
  2. 2.Department of Interventional RadiologySree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST)ThiruvananthapuramIndia

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