Evaluating Middle Cerebral Artery Atherosclerotic Lesions in Acute Ischemic Stroke Using Magnetic Resonance T1-weighted 3-Dimensional Vessel Wall Imaging
Evaluating Middle Cerebral Artery Atherosclerotic Lesions in Acute Ischemic Stroke Using Magnetic Resonance T1-weighted 3-Dimensional Vessel Wall Imaging
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DOI：
10.1016/j.jstrokecerebrovasdis.2013.06.025
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发表时间：
2014-04-01
影响因子：
2.5
通讯作者：
Terayama, Yasuo
中科院分区：
文献类型：
--
作者：
Natori, Tatsunori;Sasaki, Makoto;Terayama, Yasuo
背景：颅内动脉粥样硬化病变是缺血性卒中的主要原因。磁共振血管造影（MRA）通常用于通过检测管腔狭窄来评估动脉粥样硬化的变化，但它不能直接显示动脉粥样硬化病变。在这里，我们使用三维血管壁成像（3D-VWI）技术来评估急性卒中时颅内动脉壁的变化。研究方法：18例大脑中动脉（MCA）区域急性非心源性栓塞性卒中患者接受了1.5 T磁共振扫描仪的前瞻性检查。T1加权（T1-W）3D-VWI采用血流敏感3D快速自旋回波技术。观察大脑中动脉壁增厚程度，计算病变与胼胝体信号强度的对比率（CR），并与MRA狭窄改变进行比较。结果如下：3D-VWI上几乎所有患者的病变同侧和对侧MCA壁增厚（分别为94.4%和94.4%），而MRA仅在1例患者中显示50%的狭窄改变（5.9%; P <0.001）。同侧MCA增厚壁的CR显著高于对侧MCA（中位数，分别为0.53和0.45; P = 0.028），表明存在由出血或脂质组成的不稳定斑块。结论：T1-W3 D-VWI可直接显示脑卒中患者颅内动脉粥样硬化病变，并可检测到提示不稳定斑块的信号变化。
Background: Atherosclerotic lesions in intracranial arteries are a leading cause of ischemic stroke. Magnetic resonance angiography (MRA) is often used to assess atherosclerotic changes by detecting luminal narrowing, whereas it cannot directly visualize atherosclerotic lesions. Here, we used a 3-dimensional vessel wall imaging (3D-VWI) technique to evaluate intracranial arterial wall changes in acute stroke. Methods: Eighteen consecutive patients with acute noncardioembolic stroke in the middle cerebral artery (MCA) territory who were prospectively examined with a 1.5-T magnetic resonance scanner were studied. T1-weighted (T1-W) 3D-VWI was obtained using a flow-sensitized 3D fast-spin echo technique. Wall thickening of MCA that suggests atherosclerotic plaques was visually evaluated and the contrast ratio (CR) of signal intensity of the lesions to that of the corpus callosum was calculated and compared with stenotic changes by MRA. Results: Wall thickenings of the MCA ipsilateral and contralateral to the lesion were observed in almost all patients on 3D-VWI (94.4% and 94.4%, respectively), whereas MRA showed stenotic changes of 50% only in 1 patient (5.9%; P < .001). The CR of the thickened wall in the ipsilateral MCA was significantly higher than that in the contralateral MCA (median, .53 and .45, respectively; P = .028), suggesting of unstable plaques consisting of hemorrhage or lipid. Conclusions: The T1-W 3D-VWI can provide direct visualization of atherosclerotic lesions of the intracranial arteries in stroke patients, and it can detect signal change suggestive of unstable plaque.