Kesav Praveen, Krishnavadana Balamurali, Kesavadas Chandrasekharan, Sreedharan Sapna E, Rajendran Adhithyan, Sukumaran Sajith, Sylaja P N
Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, 695011, India.
Department of Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India.
Neuroradiology. 2019 Apr;61(4):389-396. doi: 10.1007/s00234-019-02157-5. Epub 2019 Jan 14.
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.
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.
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).
HRVWI is a useful noninvasive adjunctive tool in the diagnostic evaluation of intracranial vasculopathies, with maximum benefit in ICAD and IVas subtypes.
磁共振成像的高分辨率血管壁成像（HRVWI）是一种新型无创成像工具，可提供有关血管壁病变的直接信息。HRVWI在鉴别缺血性卒中各种颅内血管病变中的作用仍在不断发展。
纳入2016年1月至2017年12月症状发作2周内的连续性缺血性卒中/TIA患者，这些患者在基线管腔成像研究中存在50%或以上的症状性血管狭窄/闭塞。卒中亚型最初仅根据管腔成像结果按照TOAST分类进行分类，随后在纳入HRVWI结果后也进行分类。
49名受试者被纳入研究。人群的中位年龄为42岁（范围11至75岁），69%为男性。纳入HRVWI结果后，38.8%的受试者被分类为颅内动脉粥样硬化疾病（ICAD），32.6%为其他确定病因的卒中（ODE）（炎症性血管病[IVas]是主要亚组[81.2%]），28.6%为病因不明的卒中（UE）。与仅根据管腔成像结果相比，HRVWI在基线UE类别中还使另外47.3%的患者实现了诊断重新分类。ICAD更可能出现偏心性血管壁增厚、偏心性血管壁强化以及T2期管腔周围高信号伴周围低信号（P < 0.001），而IVas更可能表现为同心性血管壁增厚伴均匀强化（P < 0.001）。
HRVWI是颅内血管病变诊断评估中一种有用的无创辅助工具，在ICAD和IVas亚型中获益最大。
