Article Figures & Data
Figures
- FIGURE.
Representative case with conventional stroke work-up with negative findings and altered etiologic classification after VW-MR imaging. Diffusion-weighted MR imaging (A) shows an acute infarct in the left MCA lenticulostriate territory. MRA anterior-posterior (B) and craniocaudal (C) projections show no/minimal narrowing of the left MCA (arrows). Sagittal T2-weighted VW-MR imaging (D) shows a cross-section through the left MCA (dashed arrow), and a magnified view (inset box) shows focal, eccentric, thickening of the superior-posterior wall of the left MCA (solid arrows). Sagittal contrast-enhanced T1-weighted VW-MR imaging (E) shows the same vessel (dashed arrow) with corresponding wall enhancement (solid arrow). The VW-MR imaging appearance is consistent with atherosclerotic plaque, and the enhancement is a finding more common in recently symptomatic plaque. Adapted with permission from Schaafsma et al.23
Tables
VW-MR Imaging Category Findings Normal Arterial wall is thin or imperceptible; no wall enhancement other than ± proximal intracranial internal carotid and vertebral arteries attributed to vasa vasorum Intracranial atherosclerotic disease Arterial wall is focally, eccentrically thickened; T2 prolongation ± enhancement immediately adjacent to the lumen and T2 shortening within the wall more peripherally; markers of disease activity include plaque enhancement and intraplaque hemorrhage Arterial dissection Arterial wall is eccentrically thickened; thickened wall has the signal characteristics of blood products; marker of disease activity is intramural signal characteristics of acute or subacute blood product Vasculitis Arterial wall is concentrically, homogeneously thickened and enhancing Reversible cerebral vasoconstriction syndrome Arterial wall is concentrically, homogeneously thickened with no (or mild) enhancement ↵a Adapted from the consensus recommendations of the Vessel Wall Imaging Study Group of the American Society of Neuroradiology.9
- Table 2:
Conventional investigations performed to determine the etiology of TIA or stroke in 205 patients
Investigation Proportion of Patients Brain imaging MR imaging (± CT) 92% (189/205) CT only 8% (16/205) Conventional vascular imaging (cervical-cerebral) CTA only 18% (36/205) MRA only 37% (75/205) CTA and MRA 23% (47/205) CTA and DSA 5% (11/205) MRA and DSA 10% (20/205) CTA, MRA, and DSA 8% (16/205) Cardiac investigations Electrocardiography 100% (205/205) Rhythm monitoring ≥24 hours 29% (59/205) Transthoracic echocardiography 68% (140/205) Transesophageal echocardiography 6% (30/205) Laboratory investigations Serology screen for vasculitis 25% (51/205) Serology screen for hypercoagulability 34% (69/205) CSF analysis 14% (28/205) Brain biopsy 2% (4/205) - Table 3:
Factors associated with revised etiologic classification when conventional stroke work-up is supplemented with VW-MR imaging
OR (95% CI) for Change in Etiologic Classification when Conventional Work-Up is Supplemented with VW-MR Imaging Univariate Logistic Regression Multivariate Logistic Regression Age 0.97a (0.95–0.99) 0.99 (0.97–1.01) Sex 1.05 (0.61–1.82) 1.14 (0.55–2.39) Time interval between symptom onset and VW-MR imaging (days) 1.00 (1.00–1.00) NA Etiologic classification based on conventional stroke work-up Intracranial arteriopathy not otherwise specified 19.59a (7.39–51.91) 8.94a (2.95–27.19) Intracranial atherosclerotic disease 0.09a (0.04–0.20) 0.15a (0.05–0.41) Undetermined etiology 0.86 (0.41–1.82) NA Vasculitis 1.58 (0.56–4.45) 1.39 (0.42–4.55) Cardioembolism 0.10a (0.23–0.46) 0.12a (0.02–0.57) Other determined etiology 0.48 (0.11–2.08) 0.43 (0.09–21.83) Small-vessel occlusion 5.21 (0.62–44.06) 4.92 (0.54–44.73) Cervical atherosclerotic disease 0.55 (0.09–3.33) NA Arterial dissection 1.39E + 9 (0.001 to ∝) NA Reversible cerebral vasoconstriction syndrome 0.41 (0.04–4.95) 0.39 (0.03–4.83) Note:—NA indicates not applicable as a factor; not included in the multivariate logistic regression.
↵a Statistically significant.
