Temporal course and implications of intracranial atherosclerotic plaque enhancement on high-resolution vessel wall MRI | springermedizin.de

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04.03.2019 | Diagnostic Neuroradiology

Temporal course and implications of intracranial atherosclerotic plaque enhancement on high-resolution vessel wall MRI

verfasst von: Robert M. Kwee, Ye Qiao, Li Liu, Steven R. Zeiler, Bruce A. Wasserman

Erschienen in: Neuroradiology | Ausgabe 6/2019

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Abstract

Purpose

Little is known about the natural history of intracranial atherosclerotic plaque enhancement and its clinical implications. Our objective was to investigate the value of follow-up high-resolution contrast-enhanced vessel wall MRI (VWMRI) for classifying culprit plaques in patients with intracranial atherosclerotic disease (ICAD).

Methods

Fourteen patients with symptomatic ICAD (50% females; median age 48 years) underwent serial 3T VWMRI. Fifty-five plaques were identified and graded based on the likelihood of having caused the ischemic event (non-culprit, indeterminate, culprit) and degree of enhancement (0, 1, 2) at baseline and follow-up (median follow-up, 140 days). For accuracy analysis, plaque enhancement at baseline and stable or increasing plaque enhancement at follow-up was tested to identify a culprit plaque, and areas under the receiver operating characteristic curves (AUCs) were compared.

Results

In 37/55 (67.3%) plaques, enhancement grade remained unchanged. Lack of enhancement was only seen in non-culprit plaques at baseline, and none developed enhancement over time. Enhancement never changed more than one grade. Thirty-seven percent (10/27) of non-culprit plaques that enhanced decreased in enhancement grade at follow-up, but no culprit plaques decreased in enhancement. AUC of baseline and follow-up plaque enhancement combined was significantly larger than AUC of baseline plaque enhancement alone to identify culprit plaques (0.733 vs. 0.567, p = 0.0001).

Conclusion

Contrast enhancement of ICAD can persist months after the ischemic event. Lack of enhancement at baseline or a decrease in enhancement at follow-up suggests that the plaque is not culprit. Persistent enhancement from baseline to follow-up improves accuracy in identifying culprit plaques.

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Titel: Temporal course and implications of intracranial atherosclerotic plaque enhancement on high-resolution vessel wall MRI
verfasst von: Robert M. Kwee
Ye Qiao
Li Liu
Steven R. Zeiler
Bruce A. Wasserman
Publikationsdatum: 04.03.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Neuroradiology / Ausgabe 6/2019
Print ISSN: 0028-3940
Elektronische ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-019-02190-4

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