Dahong Yang1, Jia Liu2, Juan Du3, Xinfeng Liu4,5,6, Weihe Yao7, Kangmo Huang7, Changsheng Zhou2, Jun Bi2, Xiaoqing Cheng2, Minmin Ma7, Wusheng Zhu7, Jun Zhang2, Longjiang Zhang2, Jun Cai2, Zhongzhao Teng8. 1. Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, No. 305 E Zhongshan Rd, Nanjing, 210002, Jiangsu Province, China. 2. Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China. 3. Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, No. 305 E Zhongshan Rd, Nanjing, 210002, Jiangsu Province, China. dujuan_200988@aliyun.com. 4. Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, No. 305 E Zhongshan Rd, Nanjing, 210002, Jiangsu Province, China. xfliu2@vip.163.com. 5. Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, No. 305 E Zhongshan Rd, Nanjing, 210002, Jiangsu Province, China. xfliu2@vip.163.com. 6. Stroke Center & Department of Neurology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China. xfliu2@vip.163.com. 7. Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, No. 305 E Zhongshan Rd, Nanjing, 210002, Jiangsu Province, China. 8. Department of Radiology, University of Cambridge, Cambridge, UK.
Abstract
OBJECTIVES: To assess the complementary value of high-resolution multi-contrast MRI (hrMRI) in identifying symptomatic patients with intracranial atherosclerosis (ICAS) who are likely to experience recurrent ischemic cerebrovascular events. METHODS: In this retrospective cohort study, eighty patients with acute ischemic events attributed to ICAS who underwent hrMRI examination between January 2015 and January 2019 were included. Median follow-up for all patients was 30 months (range: 1 to 52 months) and recurrent ischemic cerebrovascular events were recorded. Cox regression analysis and time-dependent ROC were performed to quantify the association between the plaque characteristics and recurrent events. RESULTS: During the follow-up, 14 patients experienced recurrent ischemic cerebrovascular events. Young males and those with diabetes and poor medication persistence were more likely to experience recurrent events. ICAS in patients with recurrence had significantly higher enhancement ratio and steepness which is defined as the ratio between the plaque height and length than those without (p < 0.001 and p = 0.015, respectively). After adjustment of clinical factors, enhancement ratio (HR, 13.13 [95% CI, 3.58-48.20], p < 0.001) and plaque steepness (HR, 110.27 [95% CI, 4.75-2560.91], p = 0.003) were independent imaging biomarkers associated with recurrent events. Time-dependent ROC indicated that integrated high enhancement ratio and steepness into clinical risk factors improved discrimination power with the ROC increased from 0.79 to 0.94 (p = 0.008). CONCLUSIONS: The enhancement ratio and plaque steepness improved the accuracy over traditional clinical risk factors in predicting recurrent ischemic cerebrovascular events for patients with ICAS. KEY POINTS: • High-resolution magnetic resonance imaging helps clinicians to evaluate high-risk Intracranial plaque. • The higher enhancement ratio and plaque steepness (= height/length) were the primary biomarkers associated with future ischemic cerebrovascular events. • High-resolution magnetic resonance imaging combined with clinical characteristics showed a higher accuracy for the prediction of recurrent events in patients with intracranial atherosclerosis.
OBJECTIVES: To assess the complementary value of high-resolution multi-contrast MRI (hrMRI) in identifying symptomatic patients with intracranial atherosclerosis (ICAS) who are likely to experience recurrent ischemic cerebrovascular events. METHODS: In this retrospective cohort study, eighty patients with acute ischemic events attributed to ICAS who underwent hrMRI examination between January 2015 and January 2019 were included. Median follow-up for all patients was 30 months (range: 1 to 52 months) and recurrent ischemic cerebrovascular events were recorded. Cox regression analysis and time-dependent ROC were performed to quantify the association between the plaque characteristics and recurrent events. RESULTS: During the follow-up, 14 patients experienced recurrent ischemic cerebrovascular events. Young males and those with diabetes and poor medication persistence were more likely to experience recurrent events. ICAS in patients with recurrence had significantly higher enhancement ratio and steepness which is defined as the ratio between the plaque height and length than those without (p < 0.001 and p = 0.015, respectively). After adjustment of clinical factors, enhancement ratio (HR, 13.13 [95% CI, 3.58-48.20], p < 0.001) and plaque steepness (HR, 110.27 [95% CI, 4.75-2560.91], p = 0.003) were independent imaging biomarkers associated with recurrent events. Time-dependent ROC indicated that integrated high enhancement ratio and steepness into clinical risk factors improved discrimination power with the ROC increased from 0.79 to 0.94 (p = 0.008). CONCLUSIONS: The enhancement ratio and plaque steepness improved the accuracy over traditional clinical risk factors in predicting recurrent ischemic cerebrovascular events for patients with ICAS. KEY POINTS: • High-resolution magnetic resonance imaging helps clinicians to evaluate high-risk Intracranial plaque. • The higher enhancement ratio and plaque steepness (= height/length) were the primary biomarkers associated with future ischemic cerebrovascular events. • High-resolution magnetic resonance imaging combined with clinical characteristics showed a higher accuracy for the prediction of recurrent events in patients with intracranial atherosclerosis.
Authors: Hunter R Underhill; Thomas S Hatsukami; Zahi A Fayad; Valentin Fuster; Chun Yuan Journal: Nat Rev Cardiol Date: 2010-01-26 Impact factor: 32.419