Correlation between intraplaque hemorrhage and new-onset embolic cerebral infarction after basilar artery angioplasty or stenting / 国际脑血管病杂志

Objective:To investigate the correlation between intraplaque hemorrhage (IPH) and new-onset embolic cerebral infarction after basilar artery angioplasty or stenting.Methods:Consecutive patients with severe basilar atherosclerotic stenosis underwent basilar artery angioplasty or stenting in the Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine from January 2015 to February 2022 were retrospectively enrolled. High resolution magnetic resonance vessel wall imaging (HRMR-VWI) and diffusion-weighted imaging (DWI) were performed within one week before procedure, and brain DWI or CT examination was performed within 72 h after procedure to determine the patients with new-onset embolic cerebral infarction.Results:A total of 32 patients were enrolled in the analyze. IPH existed in 10 patients with basilar artery culprit plaque, and 5 had new-onset embolic cerebral infarction after procedure. The incidence of embolic cerebral infarction in the IPH group was significantly higher than that in the non-IPH group (50% vs. 0%; P=0.001). The proportion of patients with IPH in the embolic cerebral infarction group was significantly higher than that in the non-embolic cerebral infarction group (100% vs. 18.5%; P=0.001). Conclusion:IPH may be associated with new-onset embolic cerebral infarction after basilar artery angioplasty or stenting.

Carotid Intraplaque Hemorrhage Imaging: Diagnostic Value of High Signal Intensity Time-of-Flight MR Angiography Compared with Magnetization-Prepared Rapid Acquisition with Gradient-Echo Sequencing

PURPOSE: To determine the value of the appearance of the high signal intensity halo sign for detecting carotid intraplaque hemorrhage (IPH) on maximum intensity projection (MIP) of time-of-flight (TOF) MR angiography (MRA), based on high signal intensity on magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) sequencing. MATERIALS AND METHODS: A total of 78 carotid arteries in 65 patients with magnetization-prepared rapid acquisition gradient-echo (MPRAGE) positive on carotid plaque MR imaging were included in this study. High-resolution MR imaging was performed on a 3.0-T scanner prior to carotid endarterectomy or carotid artery stenting. Fast spin-echo T1- and T2-weighted axial imaging, TOF, and MPRAGE sequences were obtained. Carotid plaques with high signal intensity on MPRAGE > 200% that of adjacent muscle on at least two consecutive slices were defined as showing IPH. Halo sign of high signal intensity around the carotid artery was found on MIP from TOF MRA. Continuous and categorical variables were compared among groups using the Mann-Whitney test and Fisher's exact tests. RESULTS: Of these 78 carotid arteries, 53 appeared as a halo sign on the TOF MRA. The total IPH volume of patients with a positive halo sign was significantly higher than that of patients without a halo sign (75.0 ± 86.8 vs. 16.3 ± 18.2, P = 0.001). The maximum IPH axial wall area in patients with a positive halo sign was significantly higher than that of patients without a halo sign (11.3 ± 9.9 vs. 3.7 ± 3.6, P = 0.000). CONCLUSION: High signal intensity halo of IPH on MIP of TOF MRA is associated with total volume and maximal axial wall area of IPH.

Carotid intraplaque hemorrhage in patients with greater than fifty percent carotid stenosis was associated an acute focal cerebral infarction

@# The purpose of this study was to assess associations between acute focal cerebral infarction of anterior circulation and carotid intraplaque hemorrhage (IPH) on magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) in patients with acute neurologic symptoms. Methods: From January 2013 to August 2017, 397 patients (median age, 76 years; male, 78.6%) with acute focal cerebral infarction on diffusion weighted imaging (DWI) were evaluated to determine the maximal wall thickness of the carotid artery, and to look for IPH on carotid MPRAGE sequences. Carotid plaques were defined as carotid artery wall thickness greater than 2 mm in at least two consecutive slices. IPH was defined as the presence in a carotid plaque of MPRAGE signal intensity greater than 200% of the intensity of adjacent muscle. Results: Of these patients with focal cerebral infarction, 165 patients of 195 carotid plaques were included this study. Sixty one (31/3%) carotid plaques of 50 (30.3%) patients were detected MPRAGE positive IPH. Maximal carotid wall thickness and degree of carotid stenosis were significantly higher in the MPRAGE positive group. MPRAGE positive IPH in patients with greater than 50% carotid stenosis was associated with an increased risk of an acute stroke event (p < 0.001), and a 2.64-fold increase in the relative risk of an acute focal stroke, compared to patients with MPRAGE negative scans. Conclusions: Carotid MPRAGE positive IPH in patients with greater than 50% carotid stenosis was associated with acute focal cerebral infarction. MPRAGE positive patients showed higher maximal carotid wall thickness and a higher percentage of carotid stenosis.

To analyse the rate of intraplaque hemorrhage in symptomatic vertebral artery stenosis by high-resolution MRI / 实用医学杂志

Objective To compare the rate of intraplaque hemorrhage between symptomatic and asymptom-atic vertebral artery stenosis groups using high-resolution magnetic resonance imaging(HR-MRI).Methods The patients diagnosed with PCI and with vertebral artery stenosis using HR-MRI were enrolled retrospectively. They were divided into symptomatic and asymptomatic groups according to whether they were detected with PCI by the re-sponsible vertebral artery stenosis before examination. All patients underwent 3D time of flight magnetic resonance angiography(3D TOF MRA)to detect the stenosis location of vertebral artery and the stenosis rate at the narrow-est. T1-weighted fat-suppressed images were positioned on the atherosclerotic plaque that the signal 150% higher than the surrounding muscle was confirmed to be intraplaque hemorrhage. Statistical significance was assessed by chi-square test or Student′s unpaired t test.Results A total of 60 patients were included in this study,28 patients in the symptomatic group and 32 patients in the asymptomatic group.The rate of vertebral artery stenosis in asymp-tomatic group was higher than symptomatic group,but there was no statistical significance[(72 ± 33)% vs.(65 ± 28)%,P=0.383];the number of intraplaque hemorrhage in symptomatic group was significantly higher than that in the asymptomatic group(9 vs.2,P=0.024).Conclusions There is a higher rate of intraplaque hemorrhage in symptomatic vertebral artery stenosis group than asymptomatic group.Intraplaque Hemorrhage could be one of risk factor of acute ischemic cerebral disease.

Carotid Intraplaque Hemorrhage is Associated with Acute Cerebral Ischemic Events and Progression of Stenosis on Magnetic Resonance Imaging

PURPOSE: To investigate the association of carotid intraplaque hemorrhage (IPH) with acute cerebral ischemic events and progression of stenosis using magnetic resonance (MR) imaging. MATERIALS AND METHODS: From April 2014 to December 2016, 53 patients underwent carotid plaque MR imaging, including magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) sequence. A total of 66 carotid arteries in 53 patients had carotid stenosis, and they were included in this study. Carotid arteries were classified according to the presence of IPH, the age of hemorrhage, and degree of stenosis. We assessed ipsilateral cerebrovascular event rates and progression of stenosis between the IPH and no-IPH groups. RESULTS: Of the 61 carotid arteries assessed, 34 (56%) had IPH, and 27 (44%) had no IPH. Acute cerebral ischemic events were more frequent in the IPH group (47% vs. 22%, P = 0.045), especially in the < 30%-stenosis group (100% vs. 0%, P = 0.028). However, there was no significant difference in the incidence of ischemic events according to the age of hemorrhage (50% vs. 44%, P = 0.492). Among the 61 carotid arteries, 20 carotid arteries had previously undergone carotid artery imaging and were evaluated for plaque progression. The trend for progression of stenosis favored the IPH group versus the no-IPH group, with a marginal P-value (20% ± 12.7 vs. 9.6% ± 5.7, P = 0.063). CONCLUSION: IPH was associated with an increased incidence of acute ischemic events, especially in the mild-stenosis group and it was also associated with progression of stenosis. Evaluation of the carotid IPH by carotid plaque MR could improve discrimination of carotid plaques that cause ischemic events and progression of stenosis.

The association between intraplaque hemorrhage of cerebral arteries and acute cerebral infarction / 实用放射学杂志

Objective To evaluate the relationship between intraplaque hemorrhage of cerebral arteries and acute cerebral infarcts. Methods 35 patients with severe stenosis in M1 segment of middle cerebral arteries (MCA)were included in this study.Intracranial TOF MRA (time of flight MR angiography)was performed to detect the stenosis in MCA,and DWI (diffusion weighted imaging) was performed to detect cerebral acute infarcts.T1 MPRAGE sequence was positioned on the stenosis in M1 segment of MCA,and intraplaque hemorrhage was determined according to high signal on T1 MRRAGE images.35 patients were divided into two groups:one group with intraplaque hemorrhage and the other group without intraplaque hemorrhage.Whether there was significant differ-ence in the incidences of acute cerebral infarcts between the two groups were determined byχ2 test.Results Intraplaque hemorrhage was detected in 1 5 patients,in which 12 patients had acute cerebral infarcts.There were no intraplaque hemorrhage in 20 patients,in which 9 patients had acute cerebral infarcts.There was significant difference in the incidences of acute cerebral infarcts between the two groups (P =0.046 <0.05).Conclusion There is a higher incidence of acute cerebral infarcts in patients with intraplaque hem-orrhage than those without intraplaque hemorrhage.Intraplaque hemorrhage in severe stenosis of cerebral arteries is a high-risk indi-cation for acute cerebral infarction.

With 3D-MPRAGE and DWI sequence evaluation of intraplaque hemorrhage before carotid artery stenting / 实用放射学杂志

Objective To assess intraplaque hemorrhage before carotid artery stenting (CAS)by use of 3D-MPRAGE and DWI sequence.Methods Thirty-two symptomatic patients who had carotid artery plaque suspected by color Doppler ultrasonography and prepared for CAS underwent 3.0T carotid high-resolution MR scans,including regular sequence,T1-weighted gradient echo three-di-mensional magnetization prepared (3D-MPRAGE ) sequence,diffusion-weighted imaging (DWI ) sequences.According to 3D-MPRAGE sequence hemorrhage and non-hemorrhage groups were divided,and measured the mean ADC values of the two groups, hemorrhage and non-hemorrhage part in the hemorrhage group.Meanwhile preoperative cerebral hemorrhage group underwent brain DWI scans.Independent samples t-test analysis was utilized by SPSS V20.0 statistical software.Results High-resolution MRI dis-played 40 plaques,fourteen hemorrhagic plaques showed by 3D-MPRAGE sequence.The mean ADC values of hemorrhage and no-hemorrhage group were(1 233.5±283.5)× 10 -6 mm2/s,(1 688.9 ± 449.6)× 10 -6 mm2/s respectively,the difference of both was significant (t=3.43,P <0.05).The mean ADC values of hemorrhage and non-hemorrhage parts in the hemorrhage group mean ADC values were (934.0 ± 387.9)× 10-6 mm2/s,(1 313.9 ± 295.0)× 10-6 mm2/s respectively;the difference of both was statistically significant (t=2.92,P < 0.05 ).The difference of mean ADC values between non-hemorrhage part in the hemorrhage group and hemorrhage group was statistically significant (t=2.80,P <0.05).Conclusion 3D-MPRAGE and DWI sequences can be evaluated intraplaque hemorrhage before CAS,and provided a reliable basis for timely clinical interventions to prevent stroke.