scholarly journals Increased Wall Enhancement During Follow-Up as a Predictor of Subsequent Aneurysmal Growth

Stroke ◽  
2020 ◽  
Vol 51 (6) ◽  
pp. 1868-1872 ◽  
Author(s):  
Florent Gariel ◽  
Wagih Ben Hassen ◽  
Grégoire Boulouis ◽  
Romain Bourcier ◽  
Denis Trystram ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Predictive Value ◽  
Vessel Wall ◽  
De Novo ◽  
Morphological Changes ◽  
Multivariable Analysis ◽  
Resonance Imaging ◽  
Unruptured Intracranial Aneurysms

Background and Purpose— Absence of arterial wall enhancement (AWE) of unruptured intracranial aneurysms (UIA) has shown promise at predicting which aneurysms will not rupture. We here tested the hypothesis that increased enhancement during follow-up (increased intensity, extension, or thickness or appearance of de novo enhancement), assessed using vessel wall magnetic resonance imaging, was associated with higher rates of subsequent growth. Methods— Patients with UIA were included between 2012 and 2018. Two readers independently rated AWE modification on 3T vessel wall magnetic resonance imaging, and morphological changes on time-of-flight magnetic resonance angiography during follow-up. Results— A total of 129 patients harboring 145 UIA (mean size 4.1 mm) met study criteria, of which 12 (8.3%) displayed morphological growth at 2 years. Of them, 8 demonstrated increased AWE during follow-up before or concurrently to morphological growth, and 4 had preexisting AWE that remained stable before growth. In the remaining 133 (nongrowing) UIAs, no AWE modifications were found. In multivariable analysis, increased AWE, not size, was associated with UIA growth (relative risk, 26.1 [95% CI, 7.4–91.7], P <0.001). Sensitivity, specificity, positive predictive value, and negative predictive value for UIA growth of increased AWE during follow-up were, respectively, of 67%, 100%, 96%, and 100%. Conclusions— Increased AWE during follow-up of conservatively managed UIAs predicts aneurysm growth over a 2-year period. This may impact UIA management towards closer monitoring or preventive treatment. Replication in a different setting is warranted.

scholarly journals Standard-Dose Atorvastatin Treatment in Patients With Symptomatic Middle Cerebral Artery Atherosclerotic Stenosis: A Vessel Wall Magnetic Resonance Imaging Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Yejun Wu ◽  
Fangbing Li ◽  
Yilin Wang ◽  
Tianxiang Hu ◽  
Honghua Gao
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Vessel Wall ◽  
Standard Dose ◽  
Density Lipoprotein ◽  
Statin Treatment ◽  
Resonance Imaging ◽  
Atorvastatin Treatment ◽  
Atherosclerotic Stenosis

Background and Purpose: Ischemic stroke can be caused by atherosclerotic lesions of the middle cerebral artery (MCA). Some studies have described the effects of statin treatment on carotid artery plaques, but little is known about the effects of statin treatment on MCA plaques. The purpose of this study was to validate the efficacy of standard-dose atorvastatin (20 mg/day) in patients with symptomatic MCA atherosclerotic stenosis (SMAS) in northern China.Materials and Methods: This study is a prospective, single-arm, single-center, 12-month follow-up observational study monitoring imaging, and clinical outcomes of standard-dose atorvastatin treatment among patients with SMAS. The primary outcomes were changes in vessel wall magnetic resonance imaging (VWMRI) and serum lipid profiles before and after (1, 3, 6, and 12 months) statin treatment.Results: A total of 46 patients were recruited for this study, and 24 patients completed the follow-up. During the follow-up period, serum non-high-density lipoprotein cholesterol concentrations gradually decreased in the patients. Fourteen patients (54.33%) had a reversal of MCA plaques and 10 patients (41.67%) had no significant progression of MCA plaques and remained stable at the follow-up endpoint. At the 12 months follow-up time-point, the treatment did not reverse vascular remodeling or change the shape and distribution of plaques. Altered serum low-density lipoprotein cholesterol (LDL-C) concentrations in patients were strongly associated with plaque reversal.Conclusion: Vessel wall magnetic resonance imaging could accurately characterize changes in MCA plaques after lipid-lowering therapy. Standard-dose atorvastatin treatment could stabilize and reverse plaques in northern Chinese patients with SMAS.

scholarly journals Vessel wall magnetic resonance imaging in intracranial aneurysms: Principles and emerging clinical applications

2019 ◽  
Vol 26 (2) ◽  
pp. 135-146 ◽  
Author(s):  
Corrado Santarosa ◽  
Branden Cord ◽  
Andrew Koo ◽  
Pervinder Bhogal ◽  
Ajay Malhotra ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Vessel Wall ◽  
Intracranial Aneurysms ◽  
High Volume ◽  
Resonance Imaging ◽  
Aneurysm Wall ◽  
Unruptured Intracranial Aneurysms ◽  
Technical Principles

Intracranial high-resolution vessel wall magnetic resonance imaging is an imaging paradigm that complements conventional imaging modalities used in the evaluation of neurovascular pathology. This review focuses on the emerging utility of vessel wall magnetic resonance imaging in the characterization of intracranial aneurysms. We first discuss the technical principles of vessel wall magnetic resonance imaging highlighting methods to determine aneurysm wall enhancement and how to avoid common interpretive pitfalls. We then review its clinical application in the characterization of ruptured and unruptured intracranial aneurysms, in particular, the emergence of aneurysm wall enhancement as a biomarker of aneurysm instability. We offer our perspective from a high-volume neurovascular center where vessel wall magnetic resonance imaging is in routine clinical use.

scholarly journals Plaque Distribution Correlates With Morphology of Lenticulostriate Arteries in Single Subcortical Infarctions

Stroke ◽  
2020 ◽  
Vol 51 (9) ◽  
pp. 2801-2809
Author(s):  
Shuai Jiang ◽  
Yuying Yan ◽  
Tang Yang ◽  
Qiange Zhu ◽  
Changyi Wang ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Vessel Wall ◽  
Morphological Changes ◽  
Control Group ◽  
Resonance Imaging ◽  
Whole Brain ◽  
Lenticulostriate Arteries ◽  
Symptomatic Side ◽  
Brain Vessel

Background and Purpose: We aimed to use novel whole-brain vessel-wall magnetic resonance imaging (WB-VWI) to investigate the association between plaque distribution of middle cerebral artery (MCA) and morphological changes of the lenticulostriate arteries (LSAs) in single subcortical infarctions. Methods: Forty single subcortical infarction patients with no relevant MCA disease on magnetic resonance angiography were prospectively enrolled. Plaque location in the MCA was dichotomized as proximal (located adjacent to the LSA origin) or distal (located distal to the LSA origin) on whole-brain vessel-wall magnetic resonance imaging. The MCAs with proximal plaques were divided into the symptomatic and asymptomatic side, and asymptomatic side MCAs without proximal plaques were the control group. The morphological characteristics of the LSAs and features of proximal plaques were analyzed. Results: A total of 71 MCAs in 40 patients were analyzed (31 on the symptomatic side, 22 on the asymptomatic side, and 18 in the control group). Superior-wall plaques of MCAs were observed more frequently on the symptomatic side than the asymptomatic side (45.2% versus 9.1%, P =0.005). The wall area index, plaque burden, and remodeling index did not differ significantly between the symptomatic and asymptomatic side. The number of LSA branches was smaller ( P =0.011) in the symptomatic side (5.48±1.88) compared with the control group (6.83±1.92). The symptomatic side exhibited shorter average length of the LSAs (23.23±3.44 versus 25.75±3.76 mm, P =0.025) and shorter average distance of the LSAs (16.47±3.11 versus 21.53±4.76 mm, P <0.001) compared with the asymptomatic side. Conclusions: Superiorly distributed MCA plaques at the LSA origin are closely associated with morphological changes of the LSA in symptomatic MCAs, suggesting that the distribution, rather than the inherent features of plaques, determines the occurrence of single subcortical infarctions. Our findings provide insight into the etiologic mechanism of branch atheromatous disease in single subcortical infarctions.

The Role of Diffusion-weighted Magnetic Resonance Imaging in the Evaluation of Anterior Cruciate and Posterior Cruciate Ligament Tears

2019 ◽  
Vol 1 ◽  
pp. 97-100
Author(s):  
Vijinder Arora ◽  
Sonali Malik ◽  
Kunwarpal Singh
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Predictive Value ◽  
Cruciate Ligament ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Conventional Mri ◽  
Anterior Cruciate

Objective: The objective of our study was to determine the role of diffusion-weighted (DW) magnetic resonance imaging (MRI) in diagnosing and differentiating between complete and partial anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears and to compare it with conventional MRI sequences. Materials and Methods: We conducted a prospective study for a period of 2 years from October 2017 to October 2019 on 30 patients with clinically suspected ACL/PCL injuries of the knee. MRI of the knee joint was performed using conventional, and DW sequences and the findings on both the sequences were assessed independently and compared with the intraoperative or follow-up MRI findings. Results: As per operative and follow-up MRI findings, the sensitivity and specificity of conventional MRI were 60% and 33.33% with a positive and negative predictive value of 47.37% and 45.45%, respectively. On the other hand, the sensitivity and specificity of DW MRI were 70.00% and 33.33% with a positive and negative predictive value of 51.22% and 52.13%, respectively. P = 0.417 was statistically not significant. Conclusion: According to our study, adding DW sequence to conventional MR sequences yielded comparable results in diagnosis and differentiation between complete and partial ACL and PCL tears.

scholarly journals Qualitative and Quantitative Wall Enhancement on Magnetic Resonance Imaging Is Associated With Symptoms of Unruptured Intracranial Aneurysms

Stroke ◽  
2021 ◽  
Vol 52 (1) ◽  
pp. 213-222
Author(s):  
Qichang Fu ◽  
Yuting Wang ◽  
Yi Zhang ◽  
Yong Zhang ◽  
Xinbin Guo ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Odds Ratio ◽  
Vessel Wall ◽  
Intracranial Aneurysms ◽  
Small Sample ◽  
Oculomotor Nerve Palsy ◽  
Resonance Imaging ◽  
Qualitative And Quantitative ◽  
Unruptured Intracranial Aneurysms

Background and Purpose: Aneurysmal wall enhancement (AWE) on vessel wall magnetic resonance imaging (VW-MRI) has been described as a new imaging biomarker of unstable unruptured intracranial aneurysms (UIAs). Previous studies of symptomatic UIAs are limited due to small sample sizes and lack of AWE quantification. Our study aims to investigate whether qualitative and quantitative assessment of AWE can differentiate symptomatic and asymptomatic UIAs. Methods: Consecutive patients with UIAs were prospectively recruited for vessel wall magnetic resonance imaging at 3T from October 2014 to October 2019. UIAs were categorized as symptomatic if presenting with sentinel headache or oculomotor nerve palsy directly related to the aneurysm. Evaluation of wall enhancement included enhancement pattern (0=none, 1=focal, and 2=circumferential) and quantitative wall enhancement index (WEI). Univariate and multivariate analyses were used to identify the parameters associated with symptoms. Results: Two hundred sixty-seven patients with 341 UIAs (93 symptomatic and 248 asymptomatic) were included in this study. Symptomatic UIAs more frequently showed circumferential AWE than asymptomatic UIAs (66.7% versus 17.3%, P <0.001), as well as higher WEI (median [interquartile range], 1.3 [1.0–1.9] versus 0.3 [0.1–0.9], P <0.001). In multivariate analysis, both AWE pattern and WEI were independent factors associated with symptoms (odds ratio=2.03 across AWE patterns [95% CI, 1.21–3.39], P =0.01; odds ratio=3.32 for WEI [95% CI, 1.51–7.26], P =0.003). The combination of AWE pattern and WEI had an area under the curve of 0.91 to identify symptomatic UIAs, with a sensitivity of 95.7% and a specificity of 73.4%. Conclusions: In a large cohort of UIAs with vessel wall magnetic resonance imaging, both AWE pattern and WEI were independently associated with aneurysm-related symptoms. The qualitative and quantitative features of AWE can potentially be used to identify unstable intracranial aneurysms.

Dural Arteriovenous Fistula Formation Secondary to Cerebral Venous Thrombosis: Longitudinal Magnetic Resonance Imaging Assessment Using 4D-Combo-MR-Venography

2021 ◽  
Author(s):  
Florian F. Schuchardt ◽  
Theo Demerath ◽  
Samer Elsheikh ◽  
Thomas Wehrum ◽  
Andreas Harloff ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Venous Thrombosis ◽  
Endovascular Treatment ◽  
Cerebral Venous Thrombosis ◽  
De Novo ◽  
Fistula Formation ◽  
Mr Venography ◽  
Resonance Imaging

Abstract Background and Purpose Dural arteriovenous fistulae (DAVFs) can develop secondary to cerebral venous thrombosis (CVT). The incidence of DAVF has not yet been investigated prospectively. Methods Between July 2012 and January 2018, combined static and dynamic 4D MR venography (4D-combo-MRV) was performed in 24 consecutive patients at diagnosis of CVT and after 6 months. 3 Tesla magnetic resonance imaging with time of flight and contrast-enhanced magnetization-prepared rapid acquisition with gradient echo were performed at baseline to evaluate the extent of thrombosis and affected vessel segments. Baseline and follow-up 4D-combo-MRV were assessed for signs of DAVF. Interrater reliability of DAVF detection and the extent of recanalization were analyzed with kappa statistics. Results DAVFs were detected in 4/30 CVT patients (13.3%, 95% confidence interval [CI] 3.3–26.7). Two of 24 patients (8.3%, 95% CI: 0–20.8) had coincidental DAVF with CVT on admission. At follow-up, de novo formation of DAVF following CVT was seen in 2/24 patients (8.3%, 95% CI: 0–20.8). Both de novo DAVFs were low grade and benign fistulae (Cognard type 1, 2a), which had developed at previously thrombosed segments. Endovascular treatment was required in two high degree lesions (Cognard 2a + b) detected at baseline and in one de novo DAVF (Cognard 1) because of debilitating headache and tinnitus. Thrombus load, vessel recanalization, and frequency of cerebral lesions (hemorrhage, ischemia) were not associated with DAVF occurrence. Conclusion This exploratory study showed that de novo DAVF formation occurs more frequently than previously described. Although de novo DAVFs were benign, 75% of all detected DAVFs required endovascular treatment. Therefore, screening for DAVF by dynamic MRV, such as 4D-combo-MRV, seems worthwhile in CVT patients.

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