Neurointervention.  2014 Feb;9(1):9-20. 10.5469/neuroint.2014.9.1.9.

High-Resolution MRI of Intracranial Atherosclerotic Disease

• Ryu CW
• Kwak HS
• Jahng GH
• Lee HN

• KMID: 1910769
• DOI: http://doi.org/10.5469/neuroint.2014.9.1.9

Abstract

Intracranial atherosclerotic disease (ICAD) causes up to 10% of all ischemic strokes, and the rate of recurrent vascular ischemic events is very high. Important predictors of vulnerability in atherosclerotic plaques include the degree of stenosis and the underlying plaque morphology. Vascular wall MRI can provide information about wall structures and atherosclerotic plaque components. High-resolution (HR)-MRI in ICAD poses a greater challenge in the neurologic fields, because a high in-plane resolution and a high signal-to-noise ratio are required for vessel wall imaging of ICAD. Until now, plaque imaging of ICAD has focused on assessing the presence of a plaque and evaluating the plaque load. Going forward, evaluation of plaque vulnerability through analysis of imaging characteristics will be a critical area of research. This review introduces the acquisition protocol for HR-MRI in ICAD and the current issues associated with imaging.

Keyword

Intracranial atherosclerotic disease; Atherosclerosis; Cerebral arteries; Magnetic resonance imaging (MRI); Vessel wall imaging

MeSH Terms

Atherosclerosis
Cerebral Arteries
Constriction, Pathologic
Magnetic Resonance Imaging*
Plaque, Atherosclerotic
Signal-To-Noise Ratio
Stroke

Figure

• 

  Fig. 1 Multimodal sequence can be acquired in intracranial HR-MRI, like as carotid wall MRI. This is an example of multimodal sequence of HR-MRI of MCA. Right carotid angiography shows severe stenosis at M1 (arrow on A). Figure B, C, and D are T1, T2 and proton density weighted HR-MRIs at this stenotic segment, consequently. These multimodal sequences of MRI show clearly thick and eccentric plaque and dark inner lumen at outer margin of MCA.

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  Fig. 2 Three dimensional T1-weighted FLAIR MRI reconstructed with axial plane can cover the wide field of view. A severe stenotic segment of left distal M1 on MR angiography (A) shows enhancing plaque (arrows) on axial contrast-enhanced T1 FLAIR MRI (B).

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  Fig. 3 These are examples of the remodeling of intracranial atherosclerotic disease. A. A 70-year-old man with asymptomatic MCA stenosis shows the smaller outer boundary of the stenotic segment (arrow on right-side figure) than contralateral side (arrow on left-side figure). B. Symptomatic MCA stenosis in a 67-year-old man shows the positive remodeling (arrow on right-side figure) which has the larger diameter than contralateral normal MCA (arrow on left-side figure).

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  Fig. 4 Patients with multiple acute infarctions at right internal borderzone (A) has severe stenosis at right M1 segment (B). T1 weighted HR-MRI reveals that circumferential high signal intensity within plaque of stenotic segment (C).

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  Fig. 5 MPRAGE MRI is one of the sensitive sequences for detection of intraplaque hemorrhage. A. MRA of symptomatic patient shows mild stenosis (arrow) at right M1. B. MPRAGE MRI shows hyperintense intraplaque hemorrhage (arrowhead) at this segment.

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  Fig. 6 An example of the enhancement of plaque at intracranial artery. A. Pre-contrast proton density weighted HR-MRI shows eccentric thick plaque at MCA. B. These plaques are strong enhanced on contrast-enhanced HR-MRI (Courtesy of DC Suh, MD).

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  Fig. 7 A. Diffusion weighted MRI showed lacunar infarction at right corona radiate, B. but MRA cannot show any stenosis at ipsilateral MCA (arrow). C. Axial plane of HR-MRI of MCA shows thick plaque (arrow) at right MCA.

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  Fig. 8 In dissection, HR-MRI can reveal methemoglobin in arterial wall that show high signal intensity on T1 weighted sequence. 47 year old man with cerebellar infarction was diagnosed vertebral artery dissection. A. Vertebral angiogram shows the eccentric stenosis at distal V4. B. HR-MRI shows intramural hematoma (arrow) with high signal intensity at the stenotic segment.

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  Fig. 9 Right internal carotid angiography shows severe stenosis at right carotid terminum and M1 (A). HR-MRI reveals that multiple small collateral vessels without significant MCA trunk (B). It is a typical finding of moyamoya disease.

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