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Research ArticleBrain

Intracranial Atherosclerotic Plaque Enhancement in Patients with Ischemic Stroke

M. Skarpathiotakis, D.M. Mandell, R.H. Swartz, G. Tomlinson and D.J. Mikulis
American Journal of Neuroradiology February 2013, 34 (2) 299-304; DOI: https://doi.org/10.3174/ajnr.A3209
M. Skarpathiotakis
aFrom the Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada.
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D.M. Mandell
aFrom the Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada.
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R.H. Swartz
aFrom the Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada.
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G. Tomlinson
aFrom the Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada.
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D.J. Mikulis
aFrom the Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada.
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  • Fig 1.
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    Fig 1.

    A, 3D reformatted MRA image demonstrating bilateral MCA stenoses (arrows). B, Diffusion-weighted image of the brain demonstrating areas of restricted diffusion/infarction in the left MCA territory. C, Coronal noncontrast T1-weighted image through the level of the MCAs. Atherosclerotic plaque is present in both the right MCA and left MCA (arrows) at the site of stenoses seen in A. D, Coronal postcontrast T1-weighted image at the same level as in C, with enhancement of the left MCA atherosclerotic plaque but not of the plaques on the right.

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    Fig 2.

    A, 3D reformatted MRA image demonstrating right MCA stenoses (arrow). B, Axial noncontrast T1-weighted image through the level of the MCAs. Atherosclerotic plaque is present in the right MCA (arrow) at the site of stenosis seen in A. C, Axial postcontrast T1-weighted image at the same level as in B, with enhancement of the right MCA atherosclerotic plaque.

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    Fig 3.

    A, 3D reformatted MRA image demonstrating midbasilar artery stenosis (arrow). B, Diffusion-weighted image of the brain demonstrating areas of restricted diffusion/infarction in the basilar artery territory. C, Coronal noncontrast T1-weighted image through the level of the basilar artery. Atherosclerotic plaque is present (arrow) at the site of stenosis seen in A. D, Coronal postcontrast T1-weighted image at the same level as in C, with enhancement of midbasilar atherosclerotic plaque.

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    Fig 4.

    Strength and presence of enhancement versus time elapsed between imaging and initial stroke presentation on a logarithmic scale. Acute, subacute, and chronic timeframes are highlighted.

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    Fig 5.

    Strength and presence of enhancement versus time elapsed between imaging and initial stroke presentation for 6 patients in whom imaging was performed at 2 separate time points.

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    Table 1:

    Sequence parameters for vessel wall imaging protocol

    TR (msec)TE (msec)TI (msec)Echo-Train LengthSection ThicknessParallel FactorFOVResolution
    T1 FLAIR pre- and postgadolinium (axial and coronal or sagittal)21081286062 mm (initially 3 mm, changed to 2 mm)216 × 22 cm384 × 384
    T2 FRFSE (axial and coronal)345092-172 mm (initially 3 mm, changed to 2 mm)216 × 22 cm512 × 512
    • Note:—FRFSE indicates fast-recovery fast spin-echo.

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    Table 2:

    Imaging performed in the acute phase

    Plaques in a Single Vascular Territory in 13 PatientsPlaques in Multiple Vascular Territories in 3 Patients
    Solitary plaque in 10/13Plaque in stroke territory
        All plaques enhanced    Solitary plaque in 3/3
    Multiple plaques in 3/13    All enhanced
        All plaques enhancedPlaque in nonstroke territory
        Solitary plaque in 2/3
            1 plaque enhanced
        Multiple plaques in 1/3
            All plaques enhanced
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    Table 3:

    Time since infarct by enhancement

    Time Since InfarctEnhancement
    NoneMildStrongTotal
    Acute phase (0–4 weeks)0 (0%)0 (0%)16 (100%)16 (55.2%)
    Subacute phase (4–12 weeks)1 (20%)3 (60%)1 (20%)5 (17.2%)
    Chronic phase (>12 weeks)4 (50%)3 (37.5%)1 (12.5%)8 (27.6%)
    Total5 (17.2%)6 (20.7%)18 (62.1%)29 (100%)
    • Note:—Fisher exact test for count data, P value = 2.8 × 10−6. Spearman correlation = −0.84 (95% CIs −0.92, −0.70).

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American Journal of Neuroradiology: 34 (2)
American Journal of Neuroradiology
Vol. 34, Issue 2
1 Feb 2013
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Cite this article
M. Skarpathiotakis, D.M. Mandell, R.H. Swartz, G. Tomlinson, D.J. Mikulis
Intracranial Atherosclerotic Plaque Enhancement in Patients with Ischemic Stroke
American Journal of Neuroradiology Feb 2013, 34 (2) 299-304; DOI: 10.3174/ajnr.A3209

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Intracranial Atherosclerotic Plaque Enhancement in Patients with Ischemic Stroke
M. Skarpathiotakis, D.M. Mandell, R.H. Swartz, G. Tomlinson, D.J. Mikulis
American Journal of Neuroradiology Feb 2013, 34 (2) 299-304; DOI: 10.3174/ajnr.A3209
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  • Previous Statin Use and High-Resolution Magnetic Resonance Imaging Characteristics of Intracranial Atherosclerotic Plaque: The Intensive Statin Treatment in Acute Ischemic Stroke Patients With Intracranial Atherosclerosis Study
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  • Differential Vascular Pathophysiologic Types of Intracranial Atherosclerotic Stroke: A High-Resolution Wall Magnetic Resonance Imaging Study
  • Imaging the Intracranial Atherosclerotic Vessel Wall Using 7T MRI: Initial Comparison with Histopathology
  • Gadolinium Enhancement of Atherosclerotic Plaque in the Middle Cerebral Artery: Relation to Symptoms and Degree of Stenosis
  • Vessel Wall Magnetic Resonance Imaging in Acute Ischemic Stroke: Effects of Embolism and Mechanical Thrombectomy on the Arterial Wall
  • Imaging Intracranial Vessel Wall Pathology With Magnetic Resonance Imaging: Current Prospects and Future Directions
  • T1 Gadolinium Enhancement of Intracranial Atherosclerotic Plaques Associated with Symptomatic Ischemic Presentations
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More in this TOC Section

  • Multimodal CT Provides Improved Performance for Lacunar Infarct Detection
  • Optimal MRI Sequence for Identifying Occlusion Location in Acute Stroke: Which Value of Time-Resolved Contrast-Enhanced MRA?
  • Evaluating the Effects of White Matter Multiple Sclerosis Lesions on the Volume Estimation of 6 Brain Tissue Segmentation Methods
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