Korean J Radiol.  2017 Dec;18(6):964-972. 10.3348/kjr.2017.18.6.964.

Differentiation of Deep Subcortical Infarction Using High-Resolution Vessel Wall MR Imaging of Middle Cerebral Artery

Affiliations
  • 1Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea. byungse.choi@gmail.com
  • 2Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.

Abstract


OBJECTIVE
To evaluate the utility of high-resolution vessel wall imaging (HR-VWI) of middle cerebral artery (MCA), and to compare HR-VWI findings between striatocapsular infarction (SC-I) and lenticulostriate infarction (LS-I).
MATERIALS AND METHODS
This retrospective study was approved by the Institutional Review Board, and informed consent was waived. From July 2009 to February 2012, 145 consecutive patients with deep subcortical infarctions (SC-I, n = 81; LS-I, n = 64) who underwent HR-VWI were included in this study. The degree of MCA stenosis and the characteristics of MCA plaque (presence, eccentricity, location, extent, T2-high signal intensity [T2-HSI], and plaque enhancement) were analyzed, and compared between SC-I and LS-I, using Fisher's exact test.
RESULTS
Stenosis was more severe in SC-I than in LS-I (p = 0.040). MCA plaque was more frequent in SC-I than in LS-I (p = 0.028), having larger plaque extent (p = 0.001), more T2-HSI (p = 0.001), and more plaque enhancement (p = 0.002). The eccentricity and location of the plaque showed no significant difference between the two groups.
CONCLUSION
Both SC-I and LS-I have similar HR-VWI findings of the MCA plaque, but SC-I had more frequent, larger plaques with greater T2-HSI and enhancement. This suggests that HR-VWI may have a promising role in assisting the differentiation of underlying pathophysiological mechanism between SC-I and LS-I.

Keyword

Middle cerebral artery; Cerebral infarction; Stroke; Magnetic Resonance imaging; Plaque; Atherosclerotic; Highresolution vessel wall imaging

MeSH Terms

Acute Disease
Adult
Aged
Aged, 80 and over
Cerebral Infarction/*diagnosis/diagnostic imaging/pathology
Chronic Disease
Constriction, Pathologic
Female
Humans
Image Processing, Computer-Assisted
*Magnetic Resonance Angiography
Male
Middle Aged
Middle Cerebral Artery/*diagnostic imaging/physiopathology
Plaque, Atherosclerotic
Retrospective Studies

Figure

  • Fig. 1 Location of MCA plaque in SC-I and LS-I.Two circular graphs show relative incidence of MCA plaque in 145 patients. MCA is segmented into 6 divisions in short-axis view. Scale 1.0 (bright yellow) refers to highest incidence of plaque (100%), and scale 0.0 (dark red) refers to lowest incidence of plaque (0%). Incidence between 0% and 100% appears in gradient color display, from maximum and minimum values. Overall incidence of MCA plaque is higher in SC-I than in LS-I, but location of plaque among 6 divisions in MCA does not differ in SC-I and LS-I. AS = antero-superior, AI = antero-inferior, I = inferior, LS-I = lenticulostriate infarction, MCA = middle cerebral artery, PI = posteroinferior, PS = postero-superior, S = superior, SC-I = striatocapsular infarction

  • Fig. 2 70-year-old female with left SC-I.A. DWI shows about 2.5 cm-sized acute SC-I in left basal ganglia and corona radiata. B. On TOF-MRA, left M1 segment of MCA shows luminal irregularity with mild stenosis (arrow). C-F. HR-VWI, including T1WI (C), PDI (D), T2WI (E), and CE-T1WI (F), demonstrates eccentric wall thickening of stenotic portion of left M1 segment, indicating atherosclerotic plaque (arrows). Note focal intraplaque T2-HSI on T2WI and contrast enhancement of plaque on CE-T1WI (arrows), suggesting plaque vulnerability. CE-T1W1 = contrast-enhanced T1WI, DWI = diffusion-weighted imaging, HR-VWI = high-resolution vessel wall imaging, MRA = MR angiography, PDI = proton density imaging, TOF = time-of-flight, T1W1 = T1weighted imaging, T2WI = T2-weighted imaging, T2-HSI = T2-high signal intensity


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