Zheng Wenqiao, Wei Hua, Bai Fan, Qu Yichun, Fan Zhichang, Li Yan, Wang Bin, Wang Yongfang, Wang Le, Wang Xiaochun
Department of Radiology, The First Hospital of Shanxi Medical University, Taiyuan, China.
Department of Medical Imaging, Shanxi Medical University, Taiyuan, China.
J Magn Reson Imaging. 2025 Sep;62(3):917-927. doi: 10.1002/jmri.29813. Epub 2025 May 15.
Different stroke mechanisms present with distinct imaging characteristics and prognosis. Multiparametric MRI can characterize these variations and may contribute to stroke secondary prevention.
To investigate the stroke mechanism subtypes and prognosis in patients with symptomatic intracranial atherosclerosis using multiparametric MRI.
Retrospective.
Two hundred and seventeen ischemic stroke patients (147 males; age 55.5 ± 11.7 years) with intracranial atherosclerosis.
FIELD STRENGTH/SEQUENCE: 3-T, dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI); High-resolution vessel wall imaging (HR-VWI): three-dimensional (3D) T1-weighted Sampling Perfection with Application optimized Contrast using different flip angle Evolution (SPACE) and contrast-enhanced T1-SPACE.
All patients underwent multiparametric MRI within 7 days of stroke symptom onset. The stroke mechanisms included branch occlusive disease (BOD), artery-to-artery embolism, hypoperfusion, and mixed mechanisms. The following imaging characteristics were assessed by three radiologists independently. HR-VWI plaque characteristics included plaque area, lipid area, lipid ratio, occlusive thrombus, degree of stenosis, plaque burden, enhancement ratio, remodeling index, and intraplaque hemorrhage (IPH). The mean transit time-Alberta Stroke Program Early Computed Tomography score (MTT-ASPECTS) based on DSC-PWI was used to evaluate perfusion impairment. During a median follow-up period of 15 months, the correlation between different stroke mechanisms and prognosis was analyzed.
Chi-squared or Fisher's exact, Kruskal-Wallis H-tests, multivariate logistic regression, and Kaplan-Meier curves. All p-values were corrected by Bonferroni correction, and p-values < 0.05 were considered statistically significant.
Mixed mechanism was the most common subtype (32.7%). Significant differences were observed in perfusion impairment, degree of stenosis, plaque burden, enhancement ratio, IPH, and remodeling among stroke mechanisms. Of these characteristics, MTT-ASPECTS (odds ratio [OR] 0.70, 95% CI 0.562-0.863) and IPH (OR 2.30, 95% CI 1.042-5.051) were significantly associated with non-BOD mechanisms. Hypoperfusion mechanism was associated with a higher risk of stroke recurrence during a median follow-up of 15 months (hazard ratio 3.97, 95% CI 1.43-11.03).
Multiparametric MRI may reveal differences in imaging characteristics among stroke mechanisms. Hypoperfusion may be associated with an increased risk of stroke recurrence.
不同的卒中机制具有不同的影像学特征和预后。多参数磁共振成像（MRI）能够描述这些差异，可能有助于卒中的二级预防。
利用多参数MRI研究症状性颅内动脉粥样硬化患者的卒中机制亚型及预后。
回顾性研究。
217例颅内动脉粥样硬化的缺血性卒中患者（147例男性；年龄55.5±11.7岁）。
场强/序列：3T，动态磁敏感对比灌注加权成像（DSC-PWI）；高分辨率血管壁成像（HR-VWI）：三维（3D）T1加权使用不同翻转角的采样完美应用优化对比采集（SPACE）序列及对比增强T1-SPACE序列。
所有患者在卒中症状发作7天内接受多参数MRI检查。卒中机制包括分支闭塞性疾病（BOD）、动脉到动脉栓塞、低灌注及混合机制。由三位放射科医生独立评估以下影像学特征。HR-VWI斑块特征包括斑块面积、脂质面积、脂质比例、闭塞性血栓、狭窄程度、斑块负荷、强化率、重塑指数及斑块内出血（IPH）。基于DSC-PWI计算的平均通过时间-阿尔伯塔卒中项目早期CT评分（MTT-ASPECTS）用于评估灌注损伤。在中位随访期15个月期间，分析不同卒中机制与预后之间的相关性。
卡方检验或Fisher精确检验、Kruskal-Wallis H检验、多因素逻辑回归及Kaplan-Meier曲线。所有p值经Bonferroni校正，p值<0.05被认为具有统计学意义。
混合机制是最常见的亚型（32.7%）。在卒中机制之间，灌注损伤、狭窄程度、斑块负荷、强化率、IPH及重塑方面观察到显著差异。在这些特征中，MTT-ASPECTS（比值比[OR]0.70，95%可信区间[CI]0.562-0.863）和IPH（OR 2.30，95%CI 1.042-5.051）与非BOD机制显著相关。在中位随访15个月期间，低灌注机制与卒中复发风险较高相关（风险比3.97，95%CI 1.43-11.03）。
多参数MRI可能揭示卒中机制之间影像学特征的差异。低灌注可能与卒中复发风险增加相关。
3级。技术效能：3级。
