Ann Clin Neurophysiol.  2021 Apr;23(1):17-28. 10.14253/acn.2021.23.1.17.

Targeting the culprit: vessel wall magnetic resonance imaging for evaluating stroke

• Kim SM
• Ha SH
• Kwon H
• Kim YJ
• Ahn SH
• Kim BJ

• KMID: 2515604
• DOI: http://doi.org/10.14253/acn.2021.23.1.17

Abstract

The pathogenesis of many strokes originates in the vessel wall. Despite this, most traditional imaging focuses on the vascular lumen. Vessel-wall magnetic resonance imaging (VWMRI) is useful for establishing the etiology of intracranial stenosis. It also provides information regarding atherosclerotic plaque composition and thus plaque vulnerability, which is an indication of its potential to cause a stroke. In this review we focus on the characteristics of VWMRI findings in various arteriopathies related to intracranial artery stenosis, and discuss the clinical implications of these findings.

Keyword

Vessel-wall magnetic resonance imaging; Ischemic stroke; Intracranial atherosclerosis; Dissection; Moyamoya disease

Figure

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  Fig. 1. Vessel-wall magnetic resonance imaging findings in a 68-year-old male with intracranial atherosclerosis. (A) Time of flight magnetic resonance angiography showing severe stenosis in the right middle cerebral artery (arrow) with few branch vessels. (B) Proton density imaging showing eccentric vessel-wall thickening and atherosclerotic plaques (arrowhead). (C) Contrast-enhanced T1-weighted imaging showing enhancement in eccentric atherosclerotic plaques (arrowheads).

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  Fig. 2. Vessel-wall magnetic resonance imaging findings in a 62-year-old female with Moyamoya disease. (A) Time of flight magnetic resonance angiography demonstrating stenosis of the right distal internal carotid artery, anterior cerebral artery, and bilateral middle cerebral arteries (arrow). (B) Proton density imaging showing concentric narrowing, decreased vessel-wall diameter, and negative remodeling (arrowhead). (C) Contrast-enhanced T1-weighted imaging showing minimal concentric enhancement (arrowhead).

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  Fig. 3. Vessel-wall magnetic resonance imaging findings in a 33-year-old female with vertebral artery dissection. (A) Time of flight magnetic resonance angiography showing occlusion of the left V3-V4 segment of the vertebral artery (arrow). (B) On proton density imaging, an intimal flap was observed as a line in the lumen (arrowhead). (C) T1-weighted imaging (T1WI) showing a hyperintense, crescent-shaped intramural hematoma (arrowhead). (D) Contrast-enhanced T1WI showing eccentric enhancement (arrowhead).

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  Fig. 4. Vessel-wall magnetic resonance imaging findings in a 30-year-old male with vasculitis. (A) Time of flight magnetic resonance angiography showing multifocal stenosis of the left middle cerebral artery (arrow). (B) Contrast-enhanced proton density imaging indicating a concentric stenosis with diffuse circumferential enhancement (arrowhead).

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