Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Assessment of Arterial Wall Enhancement for Differentiation of Parent Artery Disease from Small Artery Disease: Comparison between Histogram Analysis and Visual Analysis on 3-Dimensional Contrast-Enhanced T1-Weighted Turbo Spin Echo MR Images at 3T

  • Jang, Jinhee (Department of Radiology, College of Medicine, The Catholic University of Korea) ;
  • Kim, Tae-Won (Department of Neurology, College of Medicine, The Catholic University of Korea) ;
  • Hwang, Eo-Jin (Department of Radiology, College of Medicine, The Catholic University of Korea) ;
  • Choi, Hyun Seok (Department of Radiology, College of Medicine, The Catholic University of Korea) ;
  • Koo, Jaseong (Department of Neurology, College of Medicine, The Catholic University of Korea) ;
  • Shin, Yong Sam (Department of Neurosurgery, College of Medicine, The Catholic University of Korea) ;
  • Jung, So-Lyung (Department of Radiology, College of Medicine, The Catholic University of Korea) ;
  • Ahn, Kook-Jin (Department of Radiology, College of Medicine, The Catholic University of Korea) ;
  • Kim, Bum-soo (Department of Radiology, College of Medicine, The Catholic University of Korea)
  • Received : 2015.04.21
  • Accepted : 2016.09.01
  • Published : 2017.04.01
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Abstract

Objective: The purpose of this study was to compare the histogram analysis and visual scores in 3T MRI assessment of middle cerebral arterial wall enhancement in patients with acute stroke, for the differentiation of parent artery disease (PAD) from small artery disease (SAD). Materials and Methods: Among the 82 consecutive patients in a tertiary hospital for one year, 25 patients with acute infarcts in middle cerebral artery (MCA) territory were included in this study including 15 patients with PAD and 10 patients with SAD. Three-dimensional contrast-enhanced T1-weighted turbo spin echo MR images with black-blood preparation at 3T were analyzed both qualitatively and quantitatively. The degree of MCA stenosis, and visual and histogram assessments on MCA wall enhancement were evaluated. A statistical analysis was performed to compare diagnostic accuracy between qualitative and quantitative metrics. Results: The degree of stenosis, visual enhancement score, geometric mean (GM), and the 90th percentile (90P) value from the histogram analysis were significantly higher in PAD than in SAD (p = 0.006 for stenosis, < 0.001 for others). The receiver operating characteristic curve area of GM and 90P were 1 (95% confidence interval [CI], 0.86-1.00). Conclusion: A histogram analysis of a relevant arterial wall enhancement allows differentiation between PAD and SAD in patients with acute stroke within the MCA territory.

Keywords

References

  1. Feldmann E, Daneault N, Kwan E, Ho KJ, Pessin MS, Langenberg P, et al. Chinese-white differences in the distribution of occlusive cerebrovascular disease. Neurology 1990;40:1541-1545
  2. Wityk RJ, Lehman D, Klag M, Coresh J, Ahn H, Litt B. Race and sex differences in the distribution of cerebral atherosclerosis. Stroke 1996;27:1974-1980 https://doi.org/10.1161/01.STR.27.11.1974
  3. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35-41 https://doi.org/10.1161/01.STR.24.1.35
  4. Skarpathiotakis M, Mandell DM, Swartz RH, Tomlinson G, Mikulis DJ. Intracranial atherosclerotic plaque enhancement in patients with ischemic stroke. AJNR Am J Neuroradiol 2013;34:299-304 https://doi.org/10.3174/ajnr.A3209
  5. Bodle JD, Feldmann E, Swartz RH, Rumboldt Z, Brown T, Turan TN. High-resolution magnetic resonance imaging: an emerging tool for evaluating intracranial arterial disease. Stroke 2013;44:287-292 https://doi.org/10.1161/STROKEAHA.112.664680
  6. Wardlaw JM. What is a lacune? Stroke 2008;39:2921-2922 https://doi.org/10.1161/STROKEAHA.108.523795
  7. Kim JS, Yoon Y. Single subcortical infarction associated with parental arterial disease: important yet neglected sub-type of atherothrombotic stroke. Int J Stroke 2013;8:197-203 https://doi.org/10.1111/j.1747-4949.2012.00816.x
  8. Yoon Y, Lee DH, Kang DW, Kwon SU, Kim JS. Single subcortical infarction and atherosclerotic plaques in the middle cerebral artery: high-resolution magnetic resonance imaging findings. Stroke 2013;44:2462-2467 https://doi.org/10.1161/STROKEAHA.113.001467
  9. Chimowitz M, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 2011;365:993-1003 https://doi.org/10.1056/NEJMoa1105335
  10. Turan TN, Cotsonis G, Lynn MJ, Wooley RH, Swanson S, Williams JE, et al. Intracranial stenosis: impact of randomized trials on treatment preferences of US neurologists and neurointerventionists. Cerebrovasc Dis 2014;37:203-211 https://doi.org/10.1159/000358120
  11. Ding D, Starke RM, Crowley RW, Liu KC. Role of stenting for intracranial atherosclerosis in the post-SAMMPRIS era. Biomed Res Int 2013;2013:304320
  12. Klein IF, Lavallee PC, Touboul PJ, Schouman-Claeys E, Amarenco P. In vivo middle cerebral artery plaque imaging by high-resolution MRI. Neurology 2006;67:327-329 https://doi.org/10.1212/01.wnl.0000225074.47396.71
  13. Swartz RH, Bhuta SS, Farb RI, Agid R, Willinsky RA, Terbrugge KG, et al. Intracranial arterial wall imaging using high-resolution 3-Tesla contrast-enhanced MRI. Neurology 2009;72:627-634 https://doi.org/10.1212/01.wnl.0000342470.69739.b3
  14. Klein IF, Lavallee PC, Mazighi M, Schouman-Claeys E, Labreuche J, Amarenco P. Basilar artery atherosclerotic plaques in paramedian and lacunar pontine infarctions: a high-resolution MRI study. Stroke 2010;41:1405-1409 https://doi.org/10.1161/STROKEAHA.110.583534
  15. Qiao Y, Zeiler SR, Mirbagheri S, Leigh R, Urrutia V, Wityk R, et al. Intracranial plaque enhancement in patients with cerebrovascular events on high-spatial-resolution MR images. Radiology 2014;271:534-542 https://doi.org/10.1148/radiol.13122812
  16. Heye T, Merkle EM, Reiner CS, Davenport MS, Horvath JJ, Feuerlein S, et al. Reproducibility of dynamic contrastenhanced MR imaging. Part II. Comparison of intra- and interobserver variability with manual region of interest placement versus semiautomatic lesion segmentation and histogram analysis. Radiology 2013;266:812-821 https://doi.org/10.1148/radiol.12120255
  17. Lee DK, Kim JS, Kwon SU, Yoo SH, Kang DW. Lesion patterns and stroke mechanism in atherosclerotic middle cerebral artery disease: early diffusion-weighted imaging study. Stroke 2005;36:2583-2588 https://doi.org/10.1161/01.STR.0000189999.19948.14
  18. Nguyen TD, De Rochefort L, Spincemaille P, Cham MD, Weinsaft JW, Prince MR, et al. Effective motion-sensitizing magnetization preparation for black blood magnetic resonance imaging of the heart. J Magn Reson Imaging 2008;28:1092-1100 https://doi.org/10.1002/jmri.21568
  19. van der Kolk AG, Zwanenburg JJ, Brundel M, Biessels GJ, Visser F, Luijten PR, et al. Intracranial vessel wall imaging at 7.0-T MRI. Stroke 2011;42:2478-2484 https://doi.org/10.1161/STROKEAHA.111.620443
  20. Samuels OB, Joseph GJ, Lynn MJ, Smith HA, Chimowitz MI. A standardized method for measuring intracranial arterial stenosis. AJNR Am J Neuroradiol 2000;21:643-646
  21. Natori T, Sasaki M, Miyoshi M, Ohba H, Katsura N, Yamaguchi M, et al. Evaluating middle cerebral artery atherosclerotic lesions in acute ischemic stroke using magnetic resonance T1-weighted 3-dimensional vessel wall imaging. J Stroke Cerebrovasc Dis 2014;23:706-711 https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.06.025
  22. Bland JM, Altman DG. Transformations, means, and confidence intervals. BMJ 1996;312:1079 https://doi.org/10.1136/bmj.312.7038.1079
  23. Dieleman N, van der Kolk AG, Zwanenburg JJ, Harteveld AA, Biessels GJ, Luijten PR, et al. Imaging intracranial vessel wall pathology with magnetic resonance imaging: current prospects and future directions. Circulation 2014;130:192-201 https://doi.org/10.1161/CIRCULATIONAHA.113.006919
  24. Mazighi M, Labreuche J, Gongora-Rivera F, Duyckaerts C, Hauw JJ, Amarenco P. Autopsy prevalence of intracranial atherosclerosis in patients with fatal stroke. Stroke 2008;39:1142-1147 https://doi.org/10.1161/STROKEAHA.107.496513
  25. Ryu CW, Jahng GH, Kim EJ, Choi WS, Yang DM. High resolution wall and lumen MRI of the middle cerebral arteries at 3 Tesla. Cerebrovasc Dis 2009;27:433-442 https://doi.org/10.1159/000209238
  26. Dieleman N, Yang W, Abrigo JM, Chu WC, van der Kolk AG, Siero JC, et al. Magnetic resonance imaging of plaque morphology, burden, and distribution in patients with symptomatic middle cerebral artery stenosis. Stroke 2016;47:1797-1802 https://doi.org/10.1161/STROKEAHA.116.013007
  27. Qiao Y, Steinman DA, Qin Q, Etesami M, Schar M, Astor BC, et al. Intracranial arterial wall imaging using threedimensional high isotropic resolution black blood MRI at 3.0 Tesla. J Magn Reson Imaging 2011;34:22-30 https://doi.org/10.1002/jmri.22592

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