DOI QR코드

DOI QR Code

Diagnostic Criteria of T1-Weighted Imaging for Detecting Intraplaque Hemorrhage of Vertebrobasilar Artery Based on Simultaneous Non-Contrast Angiography and Intraplaque Hemorrhage Imaging

  • Lim, Sukjoon (Jeonbuk National University Medical School) ;
  • Kim, Nam Hyeok (Jeonbuk National University Medical School) ;
  • Kwak, Hyo Sung (Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital) ;
  • Hwang, Seung Bae (Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital) ;
  • Chung, Gyung Ho (Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital)
  • Received : 2021.07.01
  • Accepted : 2021.10.01
  • Published : 2021.12.30

Abstract

Purpose: To investigate the diagnostic criteria of T1-weighted imaging (T1W) and time-of-flight (TOF) imaging for detecting intraplaque hemorrhage (IPH) of a vertebrobasilar artery (VBA) compared with simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP) imaging. Materials and Methods: Eighty-seven patients with VBA atherosclerosis who underwent high resolution MR imaging for evaluation of VBA plaque were reviewed. The presence and location of VBA plaque and IPH on SNAP were determined. The signal intensity (SI) of the VBA plaque on T1W and TOF imaging was manually measured and the SI ratio against adjacent muscles was calculated. The receiver-operating characteristic (ROC) curve was used to compare the diagnostic accuracy for detecting VBA IPH. Results: Of 87 patients, 67 had IPH and 20 had no IPH on SNAP. The SI ratio between VBA IPH and temporalis muscle on T1W was significantly higher than that in the no-IPH group (235.9 ± 16.8 vs. 120.0 ± 5.1, P < 0.001). The SI ratio between IPH and temporalis muscle on TOF was also significantly higher than that in the no-IPH group (236.8 ± 13.3 vs. 112.8 ± 7.4, P < 0.001). Diagnostic efficacies of SI ratios on TOF and TIW were excellent (AUC: 0.976 on TOF and 0.964 on T1W; cutoff value: 136.7% for TOF imaging and 135.1% for T1W imaging). Conclusion: Compared with SNAP, cutoff levels of the SI ratio between VBA plaque and temporalis muscle on T1W and TOF imaging for detecting IPH were approximately 1.35 times.

Keywords

Acknowledgement

Competing interests: The authors declare that they have no conflicts of interest.

References

  1. Gulli G, Marquardt L, Rothwell PM, Markus HS. Stroke risk after posterior circulation stroke/transient ischemic attack and its relationship to site of vertebrobasilar stenosis: pooled data analysis from prospective studies. Stroke 2013;44:598-604 https://doi.org/10.1161/STROKEAHA.112.669929
  2. Labropoulos N, Nandivada P, Bekelis K. Stroke of the posterior cerebral circulation. Int Angiol 2011;30:105-114
  3. Savitz SI, Caplan LR. Vertebrobasilar disease. N Engl J Med 2005;352:2618-2626 https://doi.org/10.1056/NEJMra041544
  4. Brandt T, von Kummer R, Muller-Kuppers M, Hacke W. Thrombolytic therapy of acute basilar artery occlusion. Variables affecting recanalization and outcome. Stroke 1996;27:875-881 https://doi.org/10.1161/01.str.27.5.875
  5. Lindsberg PJ, Soinne L, Roine RO, Tatlisumak T. Options for recanalization therapy in basilar artery occlusion. Stroke 2005;36:203-204 https://doi.org/10.1161/01.str.0000153796.49137.e8
  6. Lindsberg PJ, Mattle HP. Therapy of basilar artery occlusion: a systematic analysis comparing intra-arterial and intravenous thrombolysis. Stroke 2006;37:922-928 https://doi.org/10.1161/01.str.0000202582.29510.6b
  7. Kolodgie FD, Gold HK, Burke AP, et al. Intraplaque hemorrhage and progression of coronary atheroma. N Engl J Med 2003;349:2316-2325 https://doi.org/10.1056/NEJMoa035655
  8. Hosseini AA, Kandiyil N, Macsweeney ST, Altaf N, Auer DP. Carotid plaque hemorrhage on magnetic resonance imaging strongly predicts recurrent ischemia and stroke. Ann Neurol 2013;73:774-784 https://doi.org/10.1002/ana.23876
  9. Liu J, Balu N, Hippe DS, et al. Semi-automatic carotid intraplaque hemorrhage detection and quantification on magnetization-prepared rapid acquisition gradient-echo (MP-RAGE) with optimized threshold selection. J Cardiovasc Magn Reson 2016;18:41 https://doi.org/10.1186/s12968-016-0260-3
  10. Li D, Zhao H, Chen X, et al. Identification of intraplaque haemorrhage in carotid artery by simultaneous non-contrast angiography and intraplaque haemorrhage (SNAP) imaging: a magnetic resonance vessel wall imaging study. Eur Radiol 2018;28:1681-1686 https://doi.org/10.1007/s00330-017-5096-1
  11. Ota H, Yarnykh VL, Ferguson MS, et al. Carotid intraplaque hemorrhage imaging at 3.0-T MR imaging: comparison of the diagnostic performance of three T1-weighted sequences. Radiology 2010;254:551-563 https://doi.org/10.1148/radiol.09090535
  12. Zhu C, Tian X, Degnan AJ, et al. Clinical significance of intraplaque hemorrhage in low- and high-grade basilar artery stenosis on high-resolution MRI. AJNR Am J Neuroradiol 2018;39:1286-1292 https://doi.org/10.3174/ajnr.A5676
  13. Wang W, Yang Q, Li D, et al. Incremental value of plaque enhancement in patients with moderate or severe basilar artery stenosis: 3.0 T high-resolution magnetic resonance study. Biomed Res Int 2017;2017:4281629 https://doi.org/10.1155/2017/4281629
  14. Xu Z, Li M, Hou Z, et al. Association between basilar artery configuration and vessel wall features: a prospective high-resolution magnetic resonance imaging study. BMC Med Imaging 2019;19:99 https://doi.org/10.1186/s12880-019-0388-3
  15. Baik SH, Kwak HS, Hwang SB, Chung GH. Three-dimensional black blood contrast enhanced magnetic resonance imaging in patients with acute ischemic stroke and negative susceptibility vessel sign. Eur J Radiol 2018;102:188-194 https://doi.org/10.1016/j.ejrad.2018.03.023
  16. Jang W, Kwak HS, Chung GH, Hwang SB. Three-dimensional black-blood contrast-enhanced MRI improves detection of intraluminal thrombi in patients with acute ischaemic stroke. Eur Radiol 2018;28:3840-3847 https://doi.org/10.1007/s00330-018-5323-4
  17. Park JS, Kwak HS, Lee JM, Koh EJ, Chung GH, Hwang SB. Association of carotid intraplaque hemorrhage and territorial acute infarction in patients with acute neurological symptoms using carotid magnetization-prepared rapid acquisition with gradient-echo. J Korean Neurosurg Soc 2015;57:94-99 https://doi.org/10.3340/jkns.2015.57.2.94
  18. Kwak HS, Hwang SB, Chung GH, Jeong SK. High-resolution magnetic resonance imaging of symptomatic middle cerebral artery dissection. J Stroke Cerebrovasc Dis 2014;23:550-553 https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.03.019
  19. Kim JH, Kwak HS, Hwang SB, Chung GH. Differential diagnosis of intraplaque hemorrhage and dissection on high-resolution MR imaging in patients with focal high signal of the vertebrobasilar artery on TOF imaging. Diagnostics (Basel) 2021;11:1024 https://doi.org/10.3390/diagnostics11061024
  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. Altaf N, Daniels L, Morgan PS, et al. Detection of intraplaque hemorrhage by magnetic resonance imaging in symptomatic patients with mild to moderate carotid stenosis predicts recurrent neurological events. J Vasc Surg 2008;47:337-342 https://doi.org/10.1016/j.jvs.2007.09.064
  22. Hishikawa T, Iihara K, Yamada N, Ishibashi-Ueda H, Miyamoto S. Assessment of necrotic core with intraplaque hemorrhage in atherosclerotic carotid artery plaque by MR imaging with 3D gradient-echo sequence in patients with high-grade stenosis. Clinical article. J Neurosurg 2010;113:890-896 https://doi.org/10.3171/2010.3.JNS091057
  23. Yamada N, Higashi M, Otsubo R, et al. Association between signal hyperintensity on T1-weighted MR imaging of carotid plaques and ipsilateral ischemic events. AJNR Am J Neuroradiol 2007;28:287-292
  24. Mendes J, Parker DL, Kim SE, Treiman GS. Reduced blood flow artifact in intraplaque hemorrhage imaging using cineMPRAGE. Magn Reson Med 2013;69:1276-1284 https://doi.org/10.1002/mrm.24354
  25. Yu JH, Kwak HS, Chung GH, Hwang SB, Park MS, Park SH. Association of intraplaque hemorrhage and acute infarction in patients with basilar artery plaque. Stroke 2015;46:2768-2772 https://doi.org/10.1161/STROKEAHA.115.009412
  26. Shi Z, Zhu C, Degnan AJ, et al. Identification of high-risk plaque features in intracranial atherosclerosis: initial experience using a radiomic approach. Eur Radiol 2018;28:3912-3921 https://doi.org/10.1007/s00330-018-5395-1
  27. Wang J, Guan M, Yamada K, et al. In vivo validation of simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP) magnetic resonance angiography: an intracranial artery study. PLoS One 2016;11:e0149130 https://doi.org/10.1371/journal.pone.0149130
  28. Turan TN, Rumboldt Z, Granholm AC, et al. Intracranial atherosclerosis: correlation between in-vivo 3T high resolution MRI and pathology. Atherosclerosis 2014;237:460-463 https://doi.org/10.1016/j.atherosclerosis.2014.10.007