Neuroimaging for Stroke
By Matthew E. Fink, MD, Editor
Feil Professor and Chairman, Department of Neurology, and Assistant Dean of Clinical Affairs, Weill Cornell Medical College; Neurologist-in-Chief, New York Presbyterian Hospital
Dr. Fink reports he is a consultant for Procter & Gamble.
High-resolution Vessel Wall Imaging
Zhaoyang Fan, from Los Angeles, reported high-resolution vessel wall imaging in patients with intracranial atherosclerotic disease, using 3T MRI. Three mechanisms have been postulated for causes of ischemic stroke with intracranial atherosclerosis — plaque rupture, plaque overgrowth, and hypoperfusion due to fixed stenosis. High-resolution vessel wall imaging remains the best way to determine the anatomic configuration and determine mechanism. Vessel wall imaging with high-resolution MR can show high T1-signal images within the vessel wall of intracranial arteries that correlate with intracranial atherosclerotic plaque that has high lipid content. By using three-dimensional imaging and image reconstruction, a whole brain arterial anatomy can be examined. Investigators studied patients who had ischemic stroke in the anterior circulation territory and performed whole brain three-dimensional MR within 14 days of the ischemic stroke. They required the presence of at least one intracranial stenosis > 50% on the symptomatic side of the brain. They studied the internal carotid artery, middle cerebral artery, and anterior cerebral artery. They studied 83 symptomatic patients, and compared symptomatic and asymptomatic sides. On the symptomatic side of the patient, they found high signal plaques in 59.3% of patients, and on the asymptomatic side, they found high signal plaques in 17.2% of patients. The investigators believe that by using high T1 signal studies with and without contrast, they can identify intraplaque hemorrhage, lipid core, and inflammatory activity within the observed plaque. Further investigation to correlate these anatomic findings with clinical symptoms will need to be pursued in the future.
These articles are based on the editor's personal interactions as a participant at the International Stroke Conference in Houston, Feb. 22-24, 2017. All interpretations and opinions are exclusively those of the editor.
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