AUTHOR=Tian Xia , Shi Zhang , Wang Zhen , Xu Bing , Peng Wen-Jia , Zhang Xue-Feng , Liu Qi , Chen Shi-Yue , Tian Bing , Lu Jian-Ping , Shao Cheng-Wei 

TITLE=Characteristics of culprit intracranial plaque without substantial stenosis in ischemic stroke using three-dimensional high-resolution vessel wall magnetic resonance imaging

JOURNAL=Frontiers in Neuroscience

VOLUME=Volume 17 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2023.1160018

DOI=10.3389/fnins.2023.1160018

ISSN=1662-453X

ABSTRACT=Background and aims We aim to analyze the difference in quantitative features between culprit and non-culprit intracranial plaque without substantial stenosis using three-dimensional high-resolution vessel wall MRI (3D hr-vw-MRI).
Methods The patients with cerebral ischemic symptoms of the unilateral anterior circulation were recruited who had nonstenotic intracranial atherosclerosis (<50%) confirmed by CTA or MRA. All patients underwent 3D hr-vwMRI within 1 month after symptom onset. 3D hr-vw-MRI characteristics, including wall thickness, plaque burden, enhancement ratio, plaque volume and intraplaque hemorrhage, and histogram features were analyzed based on T2-, precontrast T1-, and postcontrast T1-weighted images. Univariate and multivariate logistic regression analysis were used to identify key determinates differentiating culprit and nonculprit plaques and to calculate the odds ratios (ORs) with 95% CIs.
Results A total of 150 plaques were identified, of which 133 plaques (97 culprit and 36 nonculprit) were in the middle cerebral artery, 3 plaques (all culprit) were in the ACA and 14 (11 culprit and 3 nonculprit) were in the ICA. Of all the quantitative parameters analyzed, plaque volume, maximum wall thickness, minimum wall thickness, plaque burden, enhancement ratio, coefficient of variation of the most stenotic site, enhancement ratio of whole culprit plaque in culprit plaques were significantly higher than those in non-culprit plaques. Multivariate logistic regression analysis found that plaque volume (OR, 1.527 [95% CI,1.231-1.894]; P < 0.001) and enhancement ratio of whole plaque (OR, 1.095 [95%CI, 1.021-1.175]; P = 0.011) were significantly associated with culprit plaque. The combination of the two features obtained a better diagnostic efficacy for culprit plaque with sensitivity and specificity (0.910 and 0.897, respectively) than each of the two parameters alone. 
Conclusion 3D hr-vwMRI features of intracranial atherosclerotic plaques provided potential values over prediction of ischemic stroke patients with non-stenotic arteries. The plaque volume and enhancement ratio of whole plaque of stenosis site were found to be effective predictive parameters.