Department of Neurology (R.F., J.A.R., H.O., A.V., S.O.-G., H.P.A., E.C.L., E.A.S.), University of Iowa Carver College of Medicine.
Department of Neurosurgery (J.A.R., S.O.-G., D.M.H., E.C.L., E.A.S.), University of Iowa Carver College of Medicine.
Stroke. 2020 Dec;51(12):3623-3631. doi: 10.1161/STROKEAHA.120.031167. Epub 2020 Oct 1.
High-resolution vessel wall imaging (HR-VWI) is a powerful tool in diagnosing intracranial vasculopathies not detected on routine imaging. We hypothesized that 7T HR-VWI may detect the presence of atherosclerotic plaques in patients with intracranial atherosclerosis disease initially misdiagnosed as cryptogenic strokes.
Patients diagnosed as cryptogenic stroke but suspected of having an intracranial arteriopathy by routine imaging were prospectively imaged with HR-VWI. If intracranial atherosclerotic plaques were identified, they were classified as culprit or nonculprit based on the likelihood of causing the index stroke. Plaque characteristics, such as contrast enhancement, degree of stenosis, and morphology, were analyzed. Contrast enhancement was determined objectively after normalization with the pituitary stalk. A cutoff value for plaque-to-pituitary stalk contrast enhancement ratio (CR) was determined for optimal prediction of the presence of a culprit plaque. A revised stroke cause was adjudicated based on clinical and HR-VWI findings.
A total of 344 cryptogenic strokes were analyzed, and 38 eligible patients were imaged with 7T HR-VWI. Intracranial atherosclerosis disease was adjudicated as the final stroke cause in 25 patients. A total of 153 intracranial plaques in 374 arterial segments were identified. Culprit plaques (n=36) had higher CR and had concentric morphology when compared with nonculprit plaques (≤0.001). CR ≥53 had 78% sensitivity for detecting culprit plaques and a 90% negative predictive value. CR ≥53 (=0.008), stenosis ≥50% (<0.001), and concentric morphology (=0.030) were independent predictors of culprit plaques.
7T HR-VWI allows identification of underlying intracranial atherosclerosis disease in a subset of stroke patients with suspected underlying vasculopathy but otherwise classified as cryptogenic. Plaque analysis in this population demonstrated that culprit plaques had more contrast enhancement (CR ≥53), caused a higher degree of stenosis, and had a concentric morphology.
高分辨率血管壁成像（HR-VWI）是一种强大的工具，可用于诊断常规成像未检测到的颅内血管病变。我们假设，7T HR-VWI 可能会在最初被误诊为隐源性中风的颅内动脉粥样硬化疾病患者中检测到粥样硬化斑块的存在。
前瞻性地对被诊断为隐源性中风但常规成像怀疑颅内血管病变的患者进行 HR-VWI 成像。如果发现颅内动脉粥样硬化斑块，则根据引起指数性中风的可能性将其分类为罪犯斑块或非罪犯斑块。分析斑块特征，如对比增强、狭窄程度和形态。通过与垂体柄进行归一化来确定对比增强的客观值。确定斑块-垂体柄对比增强比（CR）的截断值，以最佳预测罪犯斑块的存在。根据临床和 HR-VWI 发现对中风病因进行修订判断。
共分析了 344 例隐源性中风，38 例符合条件的患者接受了 7T HR-VWI 成像。25 例患者被判定为颅内动脉粥样硬化疾病为最终中风病因。共在 374 个动脉节段中发现 153 个颅内斑块。罪犯斑块（n=36）的 CR 更高，且与非罪犯斑块相比呈同心形态（均<0.001）。CR≥53 对检测罪犯斑块的敏感性为 78%，阴性预测值为 90%。CR≥53（=0.008）、狭窄≥50%（<0.001）和同心形态（=0.030）是罪犯斑块的独立预测因子。
7T HR-VWI 可在疑似潜在血管病变但被归类为隐源性的部分中风患者中识别潜在的颅内动脉粥样硬化疾病。对该人群的斑块分析表明，罪犯斑块具有更高的对比增强（CR≥53）、引起更高程度的狭窄和同心形态。
