Fang Wu1, Haiqing Song1, Qingfeng Ma1, Jiayu Xiao1, Tao Jiang1, Xiaoqin Huang1, Xiaoming Bi1, Xiuhai Guo1, Debiao Li1, Qi Yang2, Xunming Ji1, Zhaoyang Fan1. 1. From the Department of Radiology, Xuanwu Hospital (F.W., Q.Y.), Department of Neurology, Xuanwu Hospital (H.S., Q.M., X.H., X.G.), Department of Neurosurgery, Xuanwu Hospital (X.J.), and Department of Radiology, Chaoyang Hospital (J.X., T.J.), Capital Medical University, Beijing, China; MR R&D, Siemens Healthcare, Los Angeles, CA (X.B.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, and Departments of Medicine and Bioengineering, University of California, Los Angeles (D.L., Q.Y., Z.F.). 2. From the Department of Radiology, Xuanwu Hospital (F.W., Q.Y.), Department of Neurology, Xuanwu Hospital (H.S., Q.M., X.H., X.G.), Department of Neurosurgery, Xuanwu Hospital (X.J.), and Department of Radiology, Chaoyang Hospital (J.X., T.J.), Capital Medical University, Beijing, China; MR R&D, Siemens Healthcare, Los Angeles, CA (X.B.); and Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, and Departments of Medicine and Bioengineering, University of California, Los Angeles (D.L., Q.Y., Z.F.). yangyangqiqi@gmail.com xunmingji2006@yeah.net.
Abstract
BACKGROUND AND PURPOSE: The aim of the present study was to investigate atherosclerotic plaque characteristics in patients with artery-to-artery (A-to-A) embolic infarction by whole-brain high-resolution magnetic resonance imaging. METHODS: Seventy-four patients (mean age, 54.7±12.1 years; 59 men) with recent stroke in the territory of middle cerebral artery because of intracranial atherosclerotic disease were prospectively enrolled. Whole-brain high-resolution magnetic resonance imaging was performed in all the patients both precontrast and postcontrast administration by using a 3-dimensional T1-weighted vessel wall magnetic resonance imaging technique known as inversion-recovery prepared sampling perfection with application-optimized contrast using different flip angle evolutions. Patients were divided into A-to-A embolic infarction and non-A-to-A embolic infarction groups based on diffusion-weighted imaging findings. The characteristics of the intracranial atherosclerotic plaques were compared between groups. RESULTS: A total of 74 intracranial atherosclerotic plaques were analyzed (36 in A-to-A embolism group and 38 in non-A-to-A embolism group). Hyperintense plaques (HIPs) were more frequently observed in A-to-A embolism group (75.0% versus 21.1%; P<0.001). Eighteen of the 27 HIPs (66.7%) demonstrated hyperintense spots or areas located adjacent to the lumen versus 9 HIPs (33.3%) located within the plaque in A-to-A embolism group. Furthermore, a higher prevalence of plaque surface irregularity was also observed in A-to-A embolism group (41.7% versus 18.4%; P=0.029). Logistic regression analysis showed that HIP was the most powerful independent predictor of A-to-A embolic infarction (P<0.001), with the odds ratio of 11.2 (95% confidence interval, 3.5-36.2). CONCLUSIONS: A-to-A embolic infarction has distinct vulnerable plaque characteristics compared with non-A-to-A embolic infarction. HIP and plaque surface irregularity may predict A-to-A embolic infarction.
BACKGROUND AND PURPOSE: The aim of the present study was to investigate atherosclerotic plaque characteristics in patients with artery-to-artery (A-to-A) embolic infarction by whole-brain high-resolution magnetic resonance imaging. METHODS: Seventy-four patients (mean age, 54.7±12.1 years; 59 men) with recent stroke in the territory of middle cerebral artery because of intracranial atherosclerotic disease were prospectively enrolled. Whole-brain high-resolution magnetic resonance imaging was performed in all the patients both precontrast and postcontrast administration by using a 3-dimensional T1-weighted vessel wall magnetic resonance imaging technique known as inversion-recovery prepared sampling perfection with application-optimized contrast using different flip angle evolutions. Patients were divided into A-to-A embolic infarction and non-A-to-A embolic infarction groups based on diffusion-weighted imaging findings. The characteristics of the intracranial atherosclerotic plaques were compared between groups. RESULTS: A total of 74 intracranial atherosclerotic plaques were analyzed (36 in A-to-A embolism group and 38 in non-A-to-A embolism group). Hyperintense plaques (HIPs) were more frequently observed in A-to-A embolism group (75.0% versus 21.1%; P<0.001). Eighteen of the 27 HIPs (66.7%) demonstrated hyperintense spots or areas located adjacent to the lumen versus 9 HIPs (33.3%) located within the plaque in A-to-A embolism group. Furthermore, a higher prevalence of plaque surface irregularity was also observed in A-to-A embolism group (41.7% versus 18.4%; P=0.029). Logistic regression analysis showed that HIP was the most powerful independent predictor of A-to-A embolic infarction (P<0.001), with the odds ratio of 11.2 (95% confidence interval, 3.5-36.2). CONCLUSIONS: A-to-A embolic infarction has distinct vulnerable plaque characteristics compared with non-A-to-A embolic infarction. HIP and plaque surface irregularity may predict A-to-A embolic infarction.
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