Jiang Qianmei, Jing Jing, Hao Zhu, Gao Yan, Liu Tao, Yang Xinjian, Lv Ming, Chen Shuo, Zhang Zhe, Liu Xinyao, Yang Xiaomeng, Jiang Sili, Wang Zhaobin, Liu Lian
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Eur Radiol. 2024 Dec 20. doi: 10.1007/s00330-024-11310-5.
To evaluate the prevalence and predictors of ischemic lesions on thin-slice DWI (2 mm) in endovascular treatments for unruptured intracranial aneurysms (UIA), particularly explore the potential relationship with pathway plaques.
Participants eligible for endovascular treatments with UIA at a national stroke center between March 2023 and August 2023 were prospectively enrolled. All participants performed thin-slice DWI (slice thickness of 2 mm) before and after procedures. Three-dimensional joint intra-and extracranial vessel wall MRI (3D-vwMRI, voxel size 0.6 × 0.6 × 0.6 mm) was scheduled to evaluate the pathway plaques for all participants. The DWI-positive numbers were ordered and divided into four equal parts, with each quartile representing 25% of the data set.
A total of 106 participants were included. Overall, none of the participants exhibited preoperative DWI-positive lesions. Following the intervention, 93.4% (99/106) of participants exhibited new DWI-positive lesions on postoperative MRI, including 5.7% (6/106) with symptomatic ischemic stroke. Compared with the lowest quartile of ischemic lesions, the highest quartile was associated with increased odds of the presence of plaque (OR = 9.4, 95% CI: 2.0-45.4; p = 0.005). The history of previous stroke (OR = 4.6, 95% CI: 1.6-14.6; p = 0.007) and the presence of plaque in the pathway (OR = 3.4, 95% CI: 1.6-7.7; p = 0.002) were identified as independent predictors of higher quartiles of DWI-positive numbers.
As revealed by thin-slice DWI, ischemic lesions related to the endovascular treatments for UIA occurred more frequently than anticipated. A history of the previous stroke and the pathway plaques were independent predictors of higher quartiles of DWI-positive numbers.
Question Previous studies using conventional MRI may underestimate DWI-positive lesions. The procedural risk of UIA coexisting with atherosclerotic plaques is still unclear. Findings Thin-slice DWI showed ischemic lesions occurred frequently (93.4%). Three-dimensional-intra-and extracranial Vessel Wall MRI revealed a positive correlation between pathway plaques and DWI lesions. Clinical relevance Neuro-interventionalists should exercise caution when managing patients with a history of previous stroke in the presence of plaques in the treatment pathway. More vigilant pre-procedural imaging should be considered to assess unstable plaque in high-risk patients.
评估未破裂颅内动脉瘤（UIA）血管内治疗中薄层扩散加权成像（DWI，层厚2mm）上缺血性病变的发生率及预测因素，尤其探讨其与路径斑块的潜在关系。
前瞻性纳入2023年3月至2023年8月在某国家级卒中中心符合UIA血管内治疗条件的参与者。所有参与者在手术前后均进行薄层DWI（层厚2mm）检查。为所有参与者安排三维颅内和颅外血管壁磁共振成像（3D-vwMRI，体素大小0.6×0.6×0.6mm）以评估路径斑块。将DWI阳性数排序并分为四等份，每个四分位数代表数据集的25%。
共纳入106名参与者。总体而言，所有参与者术前均未出现DWI阳性病变。干预后，93.4%（99/106）的参与者术后MRI出现新的DWI阳性病变，其中5.7%（6/106）发生有症状的缺血性卒中。与缺血性病变最低四分位数相比，最高四分位数与斑块存在几率增加相关（OR = 9.4，95%CI：2.0 - 45.4；p = 0.005）。既往卒中史（OR = 4.6，95%CI：1.6 - 14.6；p = 0.007）和路径中存在斑块（OR = 3.4，95%CI：1.6 - 7.7；p = 0.002）被确定为DWI阳性数较高四分位数的独立预测因素。
薄层DWI显示，UIA血管内治疗相关的缺血性病变发生率高于预期。既往卒中史和路径斑块是DWI阳性数较高四分位数的独立预测因素。
问题 以往使用传统MRI的研究可能低估了DWI阳性病变。UIA与动脉粥样硬化斑块共存的手术风险仍不明确。发现 薄层DWI显示缺血性病变频繁发生（93.4%）。三维颅内和颅外血管壁MRI显示路径斑块与DWI病变之间呈正相关。临床意义 神经介入医生在治疗路径存在斑块的情况下，处理有既往卒中史的患者时应谨慎。应考虑更严格的术前成像以评估高危患者的不稳定斑块。
