Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Stroke Vasc Neurol. 2019 Jun 20;4(2):102-104. doi: 10.1136/svn-2018-000210. eCollection 2019 Jul.
High-resolution MRI (HRMRI) has emerged as a useful tool for clinical research in recent years. Compared with traditional cranial and vessel imaging, HRMRI provides more additional valuable pathophysiology information that is helpful for the differential diagnosis of intracranial atherosclerosis, dissection and vasculitis. However, there are some points that a neurologist should keep in mind. First, although enhanced vessel wall imaging is widely applied for research purposes, it is not appropriate for routine clinical use. Any injury or inflammation within vessel wall can result in enhancement, which is unspecific for a diagnosis. Second, although plaque components identified on HRMRI arouse researchers' interest, they may have limited positive predictive value for future stroke. Ruptured plaques may have higher prevalence in asymptomatic patients than expected. More prospective observational studies are required. Third, the vessel wall morphology features remain the useful and reliable clue for a diagnosis. It is true that eccentric vessel wall lesions most likely represent atherosclerosis if vessel dissection is easily excluded. For concentric wall lesions, however, the underlying pathophysiology is complicated, either atherosclerotic or non-atherosclerotic. Fourth, HRMRI can show luminal thrombus directly and provide valuable details. All in all, when HRMRI is used by a neurologist, it should not be viewed as the only key for a diagnosis. The diagnosis should be made based on patient history, lab works, other imaging technique and even genetic examinations.
高分辨率磁共振成像（HRMRI）近年来已成为临床研究的有用工具。与传统的颅脑和血管成像相比，HRMRI 提供了更多有价值的附加病理生理学信息，有助于颅内动脉粥样硬化、夹层和血管炎的鉴别诊断。然而，神经科医生应该注意以下几点。首先，虽然增强血管壁成像广泛应用于研究目的，但不适合常规临床使用。血管壁内的任何损伤或炎症都可能导致增强，这对诊断没有特异性。其次，尽管 HRMRI 上识别的斑块成分引起了研究人员的兴趣，但它们对未来卒中的阳性预测值可能有限。无症状患者中破裂斑块的发生率可能高于预期。需要更多的前瞻性观察性研究。第三，血管壁形态特征仍然是诊断的有用和可靠线索。如果容易排除血管夹层，偏心性血管壁病变极有可能代表动脉粥样硬化。然而，对于同心性壁病变，其潜在的病理生理学是复杂的，既可以是动脉粥样硬化性的，也可以是非动脉粥样硬化性的。第四，HRMRI 可以直接显示管腔血栓，并提供有价值的细节。总之，当神经科医生使用 HRMRI 时，不应将其视为唯一的诊断关键。诊断应基于患者病史、实验室检查、其他影像学技术甚至基因检查。
