Jong-Won Chung1, Beom Joon Kim2, Byung Se Choi3, Chul Ho Sohn4, Hee-Joon Bae5, Byung-Woo Yoon6, Seung-Hoon Lee7. 1. Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea; Clinical Research Center for Stroke, Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea. 2. Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea; Clinical Research Center for Stroke, Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Neurology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea. 3. Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea. 4. Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea. 5. Clinical Research Center for Stroke, Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea. 6. Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea. 7. Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: sb0516@snu.ac.kr.
Abstract
BACKGROUND: Symptomatic intracranial vertebral artery (VA) disease has various clinical features and poor neurological outcomes. The disease is believed to result from atherosclerotic stenosis, occlusion, or spontaneous VA dissection. The underlying histopathology of symptomatic intracranial VA disease has only been studied at postmortem, and no in vivo imaging investigation has been conducted despite the increased sophistication of imaging techniques. METHODS: The authors performed high-resolution magnetic resonance imaging (HR-MRI) of intracranial vertebral arteries in 9 patients, suspected of a VA pathology by magnetic resonance imaging (MRI), magnetic resonance angiography, and digital subtraction angiography. RESULTS: HR-MRI allowed the authors to determine the following: (1) atherosclerotic plaque is composed of a large lipid core with intraplaque hemorrhage and calcification, (2) nonstenotic atherosclerosis exhibits diffuse vessel wall thickening and plaque protruding toward perforating arteries, and (3) spontaneous VA dissection exhibits large intramural hematoma in a false lumen with complete occlusion of the true lumen. In addition, VA hypoplasia was easily differentiated from atherosclerotic stenosis, by direct visualization of a narrow lumen diameter without arterial wall thickening. Furthermore, etiologic diagnoses based on classical MRI, angiography, and digital subtraction angiography were changed in 3 patients after HR-MRI. Additional information on plaque stability, indicating the possibility of unstable plaque, was found in 4 patients. CONCLUSIONS: The application of HR-MRI in stroke patients with VA pathologies enabled the authors to determine the underlying pathophysiologies. These findings could be used to improve risk stratification and treatment decision making in symptomatic intracranial VA disease.
BACKGROUND: Symptomatic intracranial vertebral artery (VA) disease has various clinical features and poor neurological outcomes. The disease is believed to result from atherosclerotic stenosis, occlusion, or spontaneous VA dissection. The underlying histopathology of symptomatic intracranial VA disease has only been studied at postmortem, and no in vivo imaging investigation has been conducted despite the increased sophistication of imaging techniques. METHODS: The authors performed high-resolution magnetic resonance imaging (HR-MRI) of intracranial vertebral arteries in 9 patients, suspected of a VA pathology by magnetic resonance imaging (MRI), magnetic resonance angiography, and digital subtraction angiography. RESULTS: HR-MRI allowed the authors to determine the following: (1) atherosclerotic plaque is composed of a large lipid core with intraplaque hemorrhage and calcification, (2) nonstenotic atherosclerosis exhibits diffuse vessel wall thickening and plaque protruding toward perforating arteries, and (3) spontaneous VA dissection exhibits large intramural hematoma in a false lumen with complete occlusion of the true lumen. In addition, VA hypoplasia was easily differentiated from atherosclerotic stenosis, by direct visualization of a narrow lumen diameter without arterial wall thickening. Furthermore, etiologic diagnoses based on classical MRI, angiography, and digital subtraction angiography were changed in 3 patients after HR-MRI. Additional information on plaque stability, indicating the possibility of unstable plaque, was found in 4 patients. CONCLUSIONS: The application of HR-MRI in strokepatients with VA pathologies enabled the authors to determine the underlying pathophysiologies. These findings could be used to improve risk stratification and treatment decision making in symptomatic intracranial VA disease.
Authors: C Zhu; X Tian; A J Degnan; Z Shi; X Zhang; L Chen; Z Teng; D Saloner; J Lu; Q Liu Journal: AJNR Am J Neuroradiol Date: 2018-05-24 Impact factor: 3.825
Authors: A G van der Kolk; J J M Zwanenburg; N P Denswil; A Vink; W G M Spliet; M J A P Daemen; F Visser; D W J Klomp; P R Luijten; J Hendrikse Journal: AJNR Am J Neuroradiol Date: 2014-12-04 Impact factor: 3.825
Authors: Matthew D Alexander; Chun Yuan; Aaron Rutman; David L Tirschwell; Gerald Palagallo; Dheeraj Gandhi; Laligam N Sekhar; Mahmud Mossa-Basha Journal: J Neurol Neurosurg Psychiatry Date: 2016-01-08 Impact factor: 10.154