Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Differentiation of Deep Subcortical Infarction Using High-Resolution Vessel Wall MR Imaging of Middle Cerebral Artery

  • Bae, Yun Jung (Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Choi, Byung Se (Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Jung, Cheolkyu (Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Yoon, Yeon Hong (Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Sunwoo, Leonard (Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Bae, Hee-Joon (Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Kim, Jae Hyoung (Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital)
  • Received : 2016.10.07
  • Accepted : 2017.04.16
  • Published : 2017.12.01
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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.

Keywords

References

  1. Jung S, Hwang SH, Kwon SB, Yu KH, Lee BC. The clinicoradiologic properties of deep small basal ganglia infarction: lacune or small striatocapsular infarction? J Neurol Sci 2005;238:47-52 https://doi.org/10.1016/j.jns.2005.06.007
  2. Boiten J, Lodder J. Large striatocapsular infarcts: clinical presentation and pathogenesis in comparison with lacunar and cortical infarcts. Acta Neurol Scand 1992;86:298-303 https://doi.org/10.1111/j.1600-0404.1992.tb05089.x
  3. Mohr JP. Lacunes. Stroke 1982;13:3-11 https://doi.org/10.1161/01.STR.13.1.3
  4. Donnan GA, Bladin PF, Berkovic SF, Longley WA, Saling MM. The stroke syndrome of striatocapsular infarction. Brain 1991;114(Pt 1A):51-70
  5. Nah HW, Kang DW, Kwon SU, Kim JS. Diversity of single small subcortical infarctions according to infarct location and parent artery disease: analysis of indicators for small vessel disease and atherosclerosis. Stroke 2010;41:2822-2827 https://doi.org/10.1161/STROKEAHA.110.599464
  6. Bogousslavsky J. The plurality of subcortical infarction. Stroke 1992;23:629-631 https://doi.org/10.1161/01.STR.23.5.629
  7. Levine RL, Lagreze HL, Dobkin JA, Turski PA. Large subcortical hemispheric infarctions. Presentation and prognosis. Arch Neurol 1988;45:1074-1077 https://doi.org/10.1001/archneur.1988.00520340028006
  8. Caplan LR. Intracranial large artery occlusive disease. Curr Neurol Neurosci Rep 2008;8:177-181 https://doi.org/10.1007/s11910-008-0028-8
  9. Fisher CM. Capsular infarcts: the underlying vascular lesions. Arch Neurol 1979;36:65-73 https://doi.org/10.1001/archneur.1979.00500380035003
  10. Lhermitte F, Gautier JC, Derouesne C. Nature of occlusions of the middle cerebral artery. Neurology 1970;20:82-88 https://doi.org/10.1212/WNL.20.1.82
  11. Zhao DL, Deng G, Xie B, Ju S, Yang M, Chen XH, et al. High-resolution MRI of the vessel wall in patients with symptomatic atherosclerotic stenosis of the middle cerebral artery. J Clin Neurosci 2015;22:700-704 https://doi.org/10.1016/j.jocn.2014.10.018
  12. Xu WH, Li ML, Gao S, Ni J, Yao M, Zhou LX, et al. Middle cerebral artery intraplaque hemorrhage: prevalence and clinical relevance. Ann Neurol 2012;71:195-198 https://doi.org/10.1002/ana.22626
  13. Xu WH, Li ML, Gao S, Ni J, Zhou LX, Yao M, et al. Plaque distribution of stenotic middle cerebral artery and its clinical relevance. Stroke 2011;42:2957-2959 https://doi.org/10.1161/STROKEAHA.111.618132
  14. Kim JM, Jung KH, Sohn CH, Moon J, Han MH, Roh JK. Middle cerebral artery plaque and prediction of the infarction pattern. Arch Neurol 2012;69:1470-1475 https://doi.org/10.1001/archneurol.2012.1018
  15. Niizuma K, Shimizu H, Takada S, Tominaga T. Middle cerebral artery plaque imaging using 3-Tesla high-resolution MRI. J Clin Neurosci 2008;15:1137-1141 https://doi.org/10.1016/j.jocn.2007.09.024
  16. Ryoo S, Lee MJ, Cha J, Jeon P, Bang OY. Differential vascular pathophysiologic types of intracranial atherosclerotic stroke: a high-resolution wall magnetic resonance imaging study. Stroke 2015;46:2815-2821 https://doi.org/10.1161/STROKEAHA.115.010894
  17. 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;44:287-29 https://doi.org/10.1161/STROKEAHA.112.664680
  18. Li ML, Xu WH, Song L, Feng F, You H, Ni J, et al. Atherosclerosis of middle cerebral artery: evaluation with high-resolution MR imaging at 3T. Atherosclerosis 2009;204:447-452 https://doi.org/10.1016/j.atherosclerosis.2008.10.019
  19. Klein IF, Lavallee PC, Schouman-Claeys E, Amarenco P. Highresolution MRI identifies basilar artery plaques in paramedian pontine infarct. Neurology 2005;64:551-552 https://doi.org/10.1212/01.WNL.0000150543.61244.06
  20. Chung JW, Kim BJ, Sohn CH, Yoon BW, Lee SH. Branch atheromatous plaque: a major cause of lacunar infarction (high-resolution MRI study). Cerebrovasc Dis Extra 2012;2:36-44 https://doi.org/10.1159/000341399
  21. van Everdingen KJ, van der Grond J, Kappelle LJ, Ramos LM, Mali WP. Diffusion-weighted magnetic resonance imaging in acute stroke. Stroke 1998;29:1783-1790 https://doi.org/10.1161/01.STR.29.9.1783
  22. Zou XD, Chung YC, Zhang L, Han Y, Yang Q, Jia J. Middle cerebral artery atherosclerotic plaques in recent small subcortical infarction: a three-dimensional high-resolution MR study. Biomed Res Int 2015;2015:540217
  23. Chung GH, Kwak HS, Hwang SB, Jin GY. High resolution MR imaging in patients with symptomatic middle cerebral artery stenosis. Eur J Radiol 2012;81:4069-4074 https://doi.org/10.1016/j.ejrad.2012.07.001
  24. 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
  25. Vergouwen MD, Silver FL, Mandell DM, Mikulis DJ, Swartz RH. Eccentric narrowing and enhancement of symptomatic middle cerebral artery stenoses in patients with recent ischemic stroke. Arch Neurol 2011;68:338-342
  26. 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
  27. Bladin PF, Berkovic SF. Striatocapsular infarction: large infarcts in the lenticulostriate arterial territory. Neurology 1984;34:1423-1430 https://doi.org/10.1212/WNL.34.11.1423
  28. Croisille P, Turjman F, Croisile B, Tournut P, Laharotte JC, Aimard G, et al. Striatocapsular infarction: MRI and MR angiography. Neuroradiology 1994;36:430-431 https://doi.org/10.1007/BF00593676
  29. Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 1987;316:1371-1375 https://doi.org/10.1056/NEJM198705283162204
  30. Thrysoe SA, Oikawa M, Yuan C, Eldrup N, Klaerke A, Paaske WP, et al. Longitudinal distribution of mechanical stresses in carotid plaques of symptomatic patients. Stroke 2010;41:1041-1043 https://doi.org/10.1161/STROKEAHA.109.571588
  31. Toutouzas K, Karanasos A, Tsiamis E, Riga M, Drakopoulou M, Synetos A, et al. New insights by optical coherence tomography into the differences and similarities of culprit ruptured plaque morphology in non-ST-elevation myocardial infarction and ST-elevation myocardial infarction. Am Heart J 2011;161:1192-1199 https://doi.org/10.1016/j.ahj.2011.03.005
  32. Shindo S, Fujii K, Shirakawa M, Uchida K, Enomoto Y, Iwama T, et al. Morphologic features of carotid plaque rupture assessed by optical coherence tomography. AJNR Am J Neuroradiol 2015;36:2140-2146 https://doi.org/10.3174/ajnr.A4404
  33. Kang CK, Park CW, Han JY, Kim SH, Park CA, Kim KN, et al. Imaging and analysis of lenticulostriate arteries using 7.0-Tesla magnetic resonance angiography. Magn Reson Med 2009;61:136-144 https://doi.org/10.1002/mrm.21786
  34. Liem MK, van der Grond J, Versluis MJ, Haan J, Webb AG, Ferrari MD, et al. Lenticulostriate arterial lumina are normal in cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy: a high-field in vivo MRI study. Stroke 2010;41:2812-2816 https://doi.org/10.1161/STROKEAHA.110.586883

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