Vessel Wall MRI for Targeting Biopsies of Intracranial Vasculitis.
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ABSTRACT:
SUBMITTER: Zeiler SR
PROVIDER: S-EPMC7655338 | biostudies-literature | 2018 Nov
REPOSITORIES: biostudies-literature
Publications
Vessel Wall MRI for Targeting Biopsies of Intracranial Vasculitis.
Zeiler S R SR Qiao Y Y Pardo C A CA Lim M M Wasserman B A BA
AJNR. American journal of neuroradiology 20180927 11
Central nervous system vasculitides are elusive diseases that are challenging to diagnose because brain biopsies have high false-negative rates. We sought to test the ability of contrast-enhanced, high-resolution 3D vessel wall MR imaging to identify vascular inflammation and direct open biopsies of intracranial target vessels and adjacent brain parenchyma. Eight of 9 specimens revealed vascular inflammation. We conclude that vessel wall MR imaging can identify inflamed intracranial vessels, ena ...[more]
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Project description:BACKGROUND AND PURPOSE:Intracranial vessel wall MR imaging plays an increasing role in diagnosing intracranial vascular diseases. For a complete assessment, pre- and postcontrast sequences are required, and including other sequences, these result in a long scan duration. Ideally, the scan time of the vessel wall sequence should be reduced. The purpose of this study was to evaluate different intracranial vessel wall sequence variants to reduce scan duration, provided an acceptable image quality can be maintained. MATERIALS AND METHODS:Starting from the vessel wall sequence that we use clinically (6:42 minutes), 6 scan variants were tested (scan duration ranging between 4:39 and 8:24 minutes), creating various trade-offs among spatial resolution, SNR, and contrast-to-noise ratio. In total, 15 subjects were scanned on a 3T MR imaging scanner: In 5 subjects, all 7 variants were performed precontrast-only, and in 10 other subjects, the fastest variant (4:39 minutes) and our clinically used variant (6:42 minutes) were performed pre- and postcontrast. RESULTS:The fastest variant (4:39 minutes) had higher or comparable SNRs/contrast-to-noise ratios of the intracranial vessel walls compared with the reference sequence (6:42 minutes). Qualitative assessment showed that the contrast-to-noise ratio was most suppressed in the fastest variant of 4:39 minutes and the variant of 6:42 minutes pre- and postcontrast. SNRs/contrast-to-noise ratios of the fastest variant were all, except one, higher compared with the variant of 6:42 minutes (P < .008). Furthermore, the fastest variant (4:39 minutes) detected all vessel wall lesions identified on the 6:42-minute variant. CONCLUSIONS:A 30% faster vessel wall sequence was developed with high SNRs/contrast-to-noise ratios that resulted in good visibility of the intracranial vessel wall.
| S-EPMC6004122 | biostudies-literature
Project description:Background and purposeSeveral studies have attempted to characterize intracranial atherosclerotic plaques by using MR imaging sequences. However, dedicated validation of these sequences with histology has not yet been performed. The current study assessed the ability of ultra-high-resolution 7T MR imaging sequences with different image contrast weightings to image plaque components, by using histology as criterion standard.Materials and methodsFive specimens of the circle of Wills were imaged at 7T with 0.11 × 0.11 mm in-plane-resolution proton attenuation-, T1-, T2-, and T2*-weighted sequences (through-plane resolution, 0.11-1 mm). Tissue samples from 13 fiducial-marked locations (per specimen) on MR imaging underwent histologic processing and atherosclerotic plaque classification. Reconstructed MR images were matched with histologic sections at corresponding locations.ResultsForty-four samples were available for subsequent evaluation of agreement or disagreement between plaque components and image contrast differences. Of samples, 52.3% (n = 23) showed no image contrast heterogeneity; this group comprised solely no lesions or early lesions. Of samples, 25.0% (n = 11, mostly advanced lesions) showed good correlation between the spatial organization of MR imaging heterogeneities and plaque components. Areas of foamy macrophages were generally seen as proton attenuation-, T2-, and T2*- hypointense areas, while areas of increased collagen content showed more ambiguous signal intensities. Five samples showed image-contrast heterogeneity without corresponding plaque components on histology; 5 other samples showed contrast heterogeneity based on intima-media artifacts.ConclusionsMR imaging at 7T has the image contrast capable of identifying both focal intracranial vessel wall thickening and distinguishing areas of different signal intensities spatially corresponding to plaque components within more advanced atherosclerotic plaques.
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Project description:ObjectiveTo approach the clinical value of MRI with vessel wall imaging (VWI) in patients with central nervous system vasculitis (CNSV), we analyzed patterns of VWI findings both at the time of initial presentation and during follow-up.MethodsStenoocclusive lesions, vessel-wall contrast enhancement (VW-CE) and diffusion-restricted lesions were analyzed in patients with a diagnosis of CNSV. On available VWI follow-up, progression, regression or stability of VW-CE were evaluated and correlated with the clinical status.ResultsOf the 45 patients included, 28 exhibited stenoses visible on MR angiography (MRA-positive) while 17 had no stenosis (MRA-negative). VW-CE was found in 2/17 MRA-negative and all MRA-positive patients (p < 0.05). 79.1% (53/67) of stenoses showed VW-CE. VW-CE was concentric in 88.3% and eccentric in 11.7% of cases. Diffusion-restricted lesions were found more frequently in relation to stenoses with VW-CE than without VW-CE (p < 0.05). 48 VW-CE lesions in 23 patients were followed over a median time of 239.5 days. 13 VW-CE lesions (27.1%) resolved completely, 14 (29.2%) showed partial regression, 17 (35.4%) remained stable and 4 (8.3%) progressed. 22/23 patients received immunosuppressive therapy for the duration of follow-up. Patients with stable or progressive VW-CE were more likely (p < 0.05) to have a relapse (14/30 cases) than patients with partial or complete regression of VW-CE (5/25 cases).ConclusionConcentric VW-CE is a common finding in medium/large-sized vessel CNSV. VW-CE might represent active inflammation in certain situations. However, follow-up VWI findings proved ambiguous as persisting VW-CE despite immunosuppressive therapy and clinical remission was a frequent finding.
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Project description:Introduction: High resolution vessel wall MRI (VW-MRI) has enabled to characterize intracranial atherosclerosis (ICAS). We studied to identify the factors for enhancement of ICAS in VW-MRI in patients with acute ischemic stroke. Methods: Consecutive patients with acute ischemic stroke or TIA who underwent VW-MRI between January 2017 and December 2017 were included. Enhancement on VW-MRI was defined as an increase in intensity on contrast-enhanced T1-weighted sequence. We compared the clinical and the radiologic findings between patients with wall enhancement and those without wall enhancement. Results: Of the 48 patients with ICAS, 28 patients revealed enhancement on VW-MRI. Patients with enhancement were more likely to have severe stenotic lesions and higher levels of total cholesterol, triglycerides, low-density cholesterol, Apo (b), and Apo (b)/Apo (a) lipoprotein ratio (p < 0.05). Multivariable analysis demonstrated that total cholesterol (OR: 5.378, 95% CI, 1.779-16.263), triglycerides (OR: 3.362, 95% CI, 1.008-11.209), low density lipoprotein cholesterol (OR: 4.226, 95% CI, 1.264-14.126), Apo (b) lipoprotein (OR: 3639.641, 95% CI, 17.854-741954.943) levels, and Apo (b)/Apo (a) lipoprotein ratio (OR, 65.514; 95% CI, 1.131-3680.239) were independently associated with enhancement of ICAS. High-density lipoprotein cholesterol and Apo (a) lipoprotein levels were not significantly different between the patients with wall enhancement and those without wall enhancement. Conclusions: The presence and severity of enhancement of ICAS was significantly associated with dyslipidemic conditions. These results suggest that strict lipid modification should be achieved for the management of ICAS.
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Project description:ObjectivesSeveral intracranial vessel wall sequences have been described in recent literature, with either 3-T or 7-T magnetic resonance imaging (MRI). In the current study, we compared 3-T and 7-T MRI in visualising both the intracranial arterial vessel wall and vessel wall lesions.MethodsTwenty-one elderly asymptomatic volunteers were scanned by 3-T and 7-T MRI with an intracranial vessel wall sequence, both before and after contrast administration. Two raters scored image quality, and presence and characteristics of vessel wall lesions.ResultsVessel wall visibility was equal or significantly better at 7 T for the studied arterial segments, even though there were more artefacts hampering assessment. The better visualisation of the vessel wall at 7 T was most prominent in the proximal anterior cerebral circulation and the posterior cerebral artery. In the studied elderly asymptomatic population, 48 vessel-wall lesions were identified at 3 T, of which 7 showed enhancement. At 7 T, 79 lesions were identified, of which 29 showed enhancement. Seventy-one percent of all 3-T lesions and 59 % of all 7-T lesions were also seen at the other field strength.ConclusionsDespite the large variability in detected lesions at both field strengths, we believe 7-T MRI has the highest potential to identify the total burden of intracranial vessel wall lesions.Key points• Intracranial vessel wall visibility was equal or significantly better at 7-T MRI • Most vessel wall lesions in the cerebral arteries were found at 7-T MRI • Many intracranial vessel wall lesions showed enhancement after contrast administration • Large variability in detected intracranial vessel wall lesions at both field strengths • Seven-tesla MRI has the highest potential to identify total burden of intracranial atherosclerosis.
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Project description:ObjectiveTo develop an automated vessel wall segmentation method using convolutional neural networks to facilitate the quantification on magnetic resonance (MR) vessel wall images of patients with intracranial atherosclerotic disease (ICAD).MethodsVessel wall images of 56 subjects were acquired with our recently developed whole-brain three-dimensional (3-D) MR vessel wall imaging (VWI) technique. An intracranial vessel analysis (IVA) framework was presented to extract, straighten, and resample the interested vessel segment into 2-D slices. A U-net-like fully convolutional networks (FCN) method was proposed for automated vessel wall segmentation by hierarchical extraction of low- and high-order convolutional features.ResultsThe network was trained and validated on 1160 slices and tested on 545 slices. The proposed segmentation method demonstrated satisfactory agreement with manual segmentations with Dice coefficient of 0.89 for the lumen and 0.77 for the vessel wall. The method was further applied to a clinical study of additional 12 symptomatic and 12 asymptomatic patients with >50% ICAD stenosis at the middle cerebral artery (MCA). Normalized wall index at the focal MCA ICAD lesions was found significantly larger in symptomatic patients compared to asymptomatic patients.ConclusionWe have presented an automated vessel wall segmentation method based on FCN as well as the IVA framework for 3-D intracranial MR VWI.SignificanceThis approach would make large-scale quantitative plaque analysis more realistic and promote the adoption of MR VWI in ICAD management.
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Project description:Background: Intracranial atherosclerotic disease (ICAD) tends to affect multiple arterial segments, and previous studies rarely performed a comprehensive plaque analysis of the entire circle of Willis for the evaluation of recurrent stroke risk. We aimed to investigate the features of circle of Willis ICAD on 3D magnetic resonance vessel wall imaging (MR-VWI) and their relationships with recurrent acute stroke. Methods: Patients with either acute ischemic stroke (within 4 weeks after stroke) or chronic ischemic stroke (after 3 months of stroke) due to intracranial atherosclerotic plaque underwent 3D contrast-enhanced MR-VWI covering major cerebral arteries. Participants were divided into three groups: first-time acute stroke, recurrent acute stroke, and chronic stroke. Culprit plaque (defined as the only lesion or the most stenotic lesion when multiple plaques were present within the same vascular territory of the stroke) and non-culprit plaque characteristics, including total plaque number, plaque thickness, plaque area, plaque burden (calculated as plaque area divided by outer wall area), enhancement ratio (ER), eccentricity, and stenosis, were measured and compared across the three groups. Associations between plaque characteristics and recurrent acute stroke were investigated by multivariate analysis. Results: A total of 176 participants (aged 61 ± 10 years, 109 men) with 702 intracranial plaques were included in this study. There were 80 patients with first-time acute stroke, 42 patients with recurrent acute stroke, and 54 patients with chronic stroke. More intracranial plaques were found per patient in the recurrent acute stroke group than in the first-time acute stroke or chronic stroke group (5.19 ± 1.90 vs. 3.71 ± 1.96 and 3.46 ± 1.33, p < 0.001). Patients in the recurrent acute stroke group had greater culprit plaque burden (p < 0.001) and higher culprit ER (p < 0.001) than the other two groups. After adjustment of clinical demographic factors, in multivariate analysis, coronary artery disease (CAD) (odds ratio, OR = 4.61; p = 0.035), total plaque number (OR = 1.54; p = 0.003), culprit plaque ER (OR = 2.50; p = 0.036), and culprit plaque burden (OR per 10% increment = 2.44; p = 0.010) were all independently associated with recurrent acute stroke compared to the first-time acute stroke. Conclusion: Increased intracranial atherosclerotic plaque number, higher culprit plaque ER, greater culprit plaque burden, and CAD are independently associated with recurrent acute stroke.
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Project description:BackgroundIntracranial aneurysms and intracranial atherosclerosis are prevalent cerebrovascular diseases, and individuals with atherosclerosis have a higher incidence of aneurysms than those without atherosclerosis. However, few studies have conducted combined analyses to investigate the potential association between intracranial aneurysms and intracranial atherosclerosis. This retrospective cross-sectional study aimed to investigate the association between the characteristics of the aneurysm wall and intracranial large arterial plaque using high-resolution vessel wall imaging (HR-VWI).MethodsHospitalized patients diagnosed with anterior circulation unruptured intracranial aneurysms (UIAs), who were diagnosed at Huashan Hospital of Fudan University in Shanghai, China, between March 2016 to February 2018, were consecutively recruited for this study. The patients' pre-treatment HR-VWI images and 3D time-of-flight magnetic resonance angiography (3D-TOF-MRA) images were collected. The patients and UIAs were divided into two groups according to the presence or absence of plaque in the M1 segment of the middle cerebral artery (MCA). Clinical information and aneurysm characteristics were compared between the two groups. Aneurysm wall enhancement (AWE) and M1 plaque were graded on scales of 0 to 2 on HR-VWI. Based on the gradings, the correlation between AWE and the M1 plaques was analyzed.ResultsA total of 109 patients with 128 saccular UIAs in the anterior circulation were enrolled in the study. Of the patients, there were 56 patients (with 65 UIAs) in the group with M1 plaque and 53 patients (with 63 UIAs) in the group without plaque. There were significant differences between the two groups in terms of both their clinical information (age and hypertension) and aneurysm characteristics (AWE pattern and AWE degree). The grades of the AWE patterns and the AWE degrees of the UIAs were higher in the group with M1 plaque than in the group without plaque. In the M1 plaque group, the grade of M1 plaque was positively correlated with the grade of AWE pattern (correlation coefficient R=0.41, P=0.001) and the grade of AWE degree (correlation coefficient R=0.50, P<0.001).ConclusionsMCA atherosclerosis plaque was associated with the AWE of saccular aneurysms. When evaluating UIAs, attention should also be paid to the large arterial wall, which may assist in assessing the stability of the aneurysm and enable better decision making.
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Project description:Background and purposeIntracranial atherosclerotic disease is a common cause of stroke worldwide. Intracranial vessel wall magnetic resonance imaging may be able to identify imaging biomarkers of symptomatic plaque. We performed a meta-analysis to evaluate the strength of association of imaging features of symptomatic plaque leading to downstream ischemic events. Effects on the strength of association were also assessed accounting for possible sources of bias and variability related to study design and magnetic resonance parameters.MethodsPubMed, Scopus, Web of Science, EMBASE, and Cochrane databases were searched up to October 2019. Two independent reviewers extracted data on study design, vessel wall magnetic resonance imaging techniques, and imaging end points. Per-lesion odds ratios (OR) were calculated and pooled using a bivariate random-effects model. Subgroup analyses, sensitivity analysis, and evaluation of publication bias were also performed.ResultsTwenty-one articles met inclusion criteria (1750 lesions; 1542 subjects). Plaque enhancement (OR, 7.42 [95% CI, 3.35-16.43]), positive remodeling (OR, 5.60 [95% CI, 2.23-14.03]), T1 hyperintensity (OR, 2.05 [95% CI, 1.27-3.32]), and surface irregularity (OR, 4.50 [95% CI, 1.39-8.57]) were significantly associated with downstream ischemic events. T2 signal intensity was not significant (P=0.59). Plaque enhancement was significantly associated with downstream ischemic events in all subgroup analyses and showed stronger associations when measured in retrospectively designed studies (P=0.02), by a radiologist as a rater (P<0.001), and on lower vessel wall magnetic resonance imaging spatial resolution sequences (P=0.02).ConclusionsPlaque enhancement, positive remodeling, T1 hyperintensity, and surface irregularity emerged as strong imaging biomarkers of symptomatic plaque in patients with ischemic events. Plaque enhancement remained significant accounting for sources of bias and variability in both study design and instrument. Future studies evaluating plaque enhancement as a predictive marker for stroke recurrence with larger sample sizes would be valuable.
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Project description:Although MRI is widely used to diagnose stenotic carotid arteries, it also detects characteristics of the atherosclerotic plaque itself, including its size, composition, and activity. These features are emerging as additional risk factors for stroke that can be feasibly acquired clinically. This paper summarizes the state of evidence for a clinical role for MRI of carotid atherosclerosis.
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