Shi Zhang, Zhang Boyu, Miao Xiyin, Zhang Shujie, Li Jing, Liu Qi, Zeng Mengsu, Lin Jiang, Lu Jianping, Wang He
Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China.
Eur Radiol. 2025 Mar;35(3):1313-1324. doi: 10.1007/s00330-024-11304-3. Epub 2025 Jan 2.
Intensive medical management has been recommended for ischemic stroke of intracranial atherosclerosis (ICAS), but 9.4-15% probability of recurrent stroke remains an inevitable reality. The characteristics of high-risk intracranial plaque that contribute to stroke recurrence after intensive therapy are unclear.
The patients of acute ischemic stroke due to ICAS from two centers were prospectively analyzed, who underwent the 3D high-resolution head and neck vessel wall magnetic resonance imaging (hr-VW-MRI) at baseline and received intensive medical management within 90 days. The morphological features, such as minimal lumen area (MLA), and histogram parameters including entropy were assessed based on hr-VW-MR images. The recurrence of ischemic events after 6 months was defined as hyperintensity on diffusion-weighted images in the ipsilateral vascular territory. Cox regression analysis was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) for recurrent events.
A total of 222 patients (age 59.5 ± 12.1; males 153) were finally included, and 38 had recurrent stroke after 6 months. After adjusting the age and gender, Cox regression demonstrated that smoking (HR = 4.321; 95% CI, 1.838-10.161; p = 0.001), taking exercise (HR = 0.409; 95% CI, 0.198-0.843; p = 0.015), blood pressure management (HR = 0.180; 95% CI, 0.073-0.443; p = 0.001), MLA (HR = 0.771; 95% CI, 0.625-0.951; p = 0.015) and entropy (HR = 0.274; 95% CI, 0.130-0.576; p = 0.001) were significant predictors of recurrent ischemic stroke. However, the area under curve value of MRI parameters was significantly higher than that of traditional clinical factors (0.86 vs 0.79; p = 0.01).
The plaque characteristics based on hr-VW-MRI may provide complementary values over traditional clinical features in predicting ischemic recurrence for ICAS.
Question The study addresses recurrent ischemic stroke in intracranial atherosclerosis patients, identifying high-risk plaque features that contribute to recurrence despite intensive medical management. Findings Plaque features on high-resolution vessel wall magnetic resonance imaging (hr-VW-MRI), such as minimal lumen area and entropy, improve prediction of stroke recurrence over clinical factors. Clinical relevance This two-center prospective study improves patient care by using hr-VW-MRI and histogram factors like entropy to better predict stroke recurrence, allowing for more personalized treatment strategies and potentially reducing ischemic events in patients with intracranial atherosclerosis.
对于颅内动脉粥样硬化性缺血性卒中（ICAS），推荐进行强化医疗管理，但仍有9.4% - 15%的卒中复发概率是不可避免的现实。强化治疗后导致卒中复发的高危颅内斑块特征尚不清楚。
对来自两个中心的因ICAS导致急性缺血性卒中的患者进行前瞻性分析，这些患者在基线时接受了3D高分辨率头颈部血管壁磁共振成像（hr - VW - MRI）检查，并在90天内接受了强化医疗管理。基于hr - VW - MR图像评估形态学特征，如最小管腔面积（MLA），以及包括熵在内的直方图参数。6个月后缺血事件复发定义为同侧血管区域弥散加权图像上的高信号。采用Cox回归分析计算复发事件的风险比（HR）和95%置信区间（CI）。
最终纳入222例患者（年龄59.5 ± 12.1岁；男性153例），其中38例在6个月后发生卒中复发。调整年龄和性别后，Cox回归显示吸烟（HR = 4.321；95% CI，1.838 - 10.161；p = 0.001）、运动（HR = 0.409；95% CI，0.198 - 0.843；p = 0.015）、血压管理（HR = 0.180；95% CI，0.073 - 0.443；p = 0.001）、MLA（HR = 0.771；95% CI，0.625 - 0.951；p = 0.015）和熵（HR = 0.274；95% CI，0.130 - 0.576；p = 0.001）是缺血性卒中复发的显著预测因素。然而，MRI参数的曲线下面积值显著高于传统临床因素（0.86对0.79；p = 0.01）。
基于hr - VW - MRI的斑块特征在预测ICAS缺血性复发方面可能比传统临床特征具有补充价值。
问题 该研究探讨颅内动脉粥样硬化患者的复发性缺血性卒中，识别出尽管进行了强化医疗管理但仍导致复发的高危斑块特征。发现 高分辨率血管壁磁共振成像（hr - VW - MRI）上的斑块特征，如最小管腔面积和熵，比临床因素能更好地预测卒中复发。临床意义 这项两中心前瞻性研究通过使用hr - VW - MRI和熵等直方图因素更好地预测卒中复发，改善了患者护理，从而能够制定更个性化的治疗策略，并可能减少颅内动脉粥样硬化患者的缺血事件。
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