Construction of recurrence prediction model after radical resection of middle and low rectal cancer based on magnetic resonance imaging measurement of perirectal fat content and its application value / 中华消化外科杂志

Objective:To investigate the influencing factors of recurrence after radical resection of middle and low rectal cancer, and to establish a prediction model based on magnetic resonance imaging (MRI) measurement of perirectal fat content and investigate its application value.Methods:The retrospective cohort study was constructed. The clinicopathological data of 254 patients with middle and low rectal cancer who were admitted to Tianjin Union Medical Center from December 2016 to December 2021 were collected. There were 188 males and 66 females, aged (61±9)years. All patients underwent radical resection of rectal cancer and routine pelvic MRI examina-tion. Observation indicators: (1) follow-up and quantitative measurement of perirectal fat content; (2) factors influencing tumor recurrence after radical resection of middle and low rectal cancer; (3) construction and evaluation of the nomogram prediction model of tumor recurrence after radical resection of middle and low rectal cancer. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(rang) and M( Q1, Q2). Count data were described as absolute numbers. Univariate and multivariate analyses were conducted using the COX regression model. The rms software package (4.1.3 version) was used to construct the nomogram and calibration curve. The survival software package (4.1.3 version) was used to calculate the C-index. The ggDCA software package (4.1.3 version) was used for decision curve analysis. Results:(1) Follow-up and quantitative measurement of perirectal fat content. All 254 patients were followed up for 41.0(range, 1.0?59.0)months after surgery. During the follow-up period, there were 81 patients undergoing tumor recurrence with the time to tumor recurrence as 15.0(range, 1.0?43.0)months, and there were 173 patients without tumor recurrence. The preoperative rectal mesangial fascia envelope volume, preoperative rectal mesangial fat area, preoperative rectal posterior mesangial thickness were 159.1(68.6,266.5)cm3, 17.0(5.1,34.4)cm2, 1.2(0.4,3.2)cm in the 81 patients with tumor recurrence, and 178.5(100.1,310.1)cm3, 19.8(5.3,40.2)cm2 and 1.6(0.3,3.7)cm in the 173 patients without tumor recurrence. (2) Factors influencing tumor recurrence after radical resection of middle and low rectal cancer. Results of multivariate analysis showed that poorly differentiated tumor, tumor pathological N staging as N1?N2 stage, rectal posterior mesangial thickness ≤1.43 cm, magnetic resonance extra mural vascular invasion, tumor invasion surrounding structures were independent risk factors of tumor recurrence after radical resection of middle and low rectal cancer ( hazard ratio=1.64, 2.20, 3.19, 1.69, 4.20, 95% confidence interval as 1.03?2.61, 1.29?3.74, 1.78?5.71, 1.02?2.81, 2.05?8.63, P<0.05). (3) Construction and evaluation of the nomogram prediction model of tumor recurrence after radical resection of middle and low rectal cancer. Based on the results of multivariate analysis, the tumor differentiation, tumor pathological N staging, rectal posterior mesangial thickness, magnetic resonance extra mural vascular invasion, tumor invasion surrounding structures were included to construct the nomogram predic-tion model of tumor recurrence after radical resection of middle and low rectal cancer. The total score of these index in the nomogram prediction model corresponded to the probability of post-operative tumor recurrence. The C-index of the nomogram was 0.80, indicating that the prediction model with good prediction accuracy. Results of calibration curve showed that the nomogram prediction model with good prediction ability. Results of decision curve showed that the prediction probability threshold range was wide when the nomogram prediction model had obvious net benefit rate, and the model had good clinical practicability. Conclusions:Poorly differentiated tumor, tumor pathological N staging as N1?N2 stage, rectal posterior mesangial thickness ≤1.43 cm, magnetic resonance extra mural vascular invasion, tumor invasion surrounding structures are independent risk factors of tumor recurrence after radical resection of middle and low rectal cancer. Nomogram prediction model based on MRI measurement of perirectal fat content can effectively predict the probability of postoperative tumor recurrence.

Evaluation of three-dimensional high-resolution magnetic resonance imaging in the diagnosis of intracranial atherosclerotic stenosis / Evaluación de resonancia magnética tridimensional de alta resolución en el diagnóstico de la estenosis aterosclerótica intracraneal

SUMMARY: Intracranial artery stenosis (ICAS) was one of the main causes of ischemic stroke onset and recurrence. About 30 % of strokes were caused by intracranial artery stenosis. Intracranial artery stenosis had a high incidence in China and faced a high risk of recurrence for a long time. It affected patient safety and quality of life seriously. At the same time, it caused a heavy financial burden for the patient´s family. Therefore, early detection and accuracy of intracranial artery stenosis evaluation were extremely important. High-resolution magnetic resonance imaging (HR-MRI) had been widely used in clinical examinations, making up for the shortcomings of traditional vascular imaging methods that could only show the degree of luminal stenosis, making it possible to perform lumens, tube wall and plaque features of atherosclerotic intracranial arteries at the same time. There were still some controversies about the credibility of this technique in assessing the intracranial artery lumen stenosis. This article reviewed the application efficacy of HR-MRI technology in evaluating the degree of intracranial atherosclerotic stenosis.

RESUMEN: La estenosis de arterias intracraneales (ICAS) es una de las principales causas del ictus isquémico, como así también de su recurrencia. Alrededor del 30 % de los ataques cerebrovasculares son causados por estenosis de la arteria intracraneal. La estenosis de arterias intracraneales tiene una alta incidencia en China y enfrenta un alto riesgo de recurrencia, afectando gravemente la seguridad y la calidad de vida de los pacientes. Al mismo tiempo, supone una importante carga financiera para la familia de los pacientes. Por lo tanto, la detección temprana y la precisión de la evaluación de la estenosis de arterias intracraneales es extremadamente importante. La resonancia magnética de alta resolución (HR-MRI, por sus siglas en inglés) es utilizada ampliamente en los exámenes clínicos, compensando las deficiencias de los métodos tradicionales de imágenes vasculares que solo pueden mostrar el grado de estenosis luminal, haciendo posible el estudio de las características del lumen, pared vascular y la placa ateroesclerótica, de las arterias intracraneales afectadas, al mismo tiempo. Aún existen algunas controversias sobre la credibilidad de esta técnica en la evaluación de la estenosis del lumen de arterias intracraneales. En este artículo se revisó la eficacia de la aplicación de la tecnología HR-MRI para evaluar el grado de estenosis aterosclerótica intracraneal.

Application of angioplasty in non-acute stage of intracranial large artery occlusion guided by highresolution magnetic resonance imaging / 中国脑血管病杂志

Objective To evaluate the feasibility, safety and clinical efficacy of endovascular angioplasty for symptomatic, non-acute occlusion of the large intracranial artery under the guidance of highresolution magnetic resonance imaging (HR-MRI). Methods A total of 31 patients with symptomatic and subacute or chronic occlusion of the large intracranial artery in the Department of Interventional Therapy, First Affiliated Hospital of Dalian Medical University from June 2017 to December 2019 was analyzed retrospectively. The location of luminal and plaque at the occlusion segment were evaluated by HR-MRI to determine the characteristic of the occlusion (thrombosis or substantial occlusion of the wall), and obtain the relationship between the plaque distribution of intracranial artery and the opening location of perforating artery. According to the evaluation results, 26 patients were screened for recanalization with angioplasty. The success rate of surgical technique, perioperative complications, and the outcomes of postoperative clinical and imaging follow-up were evaluated. The modified Rankin scale (mRS) was used to assess the patient's prognosis. Results Of the 26 patients undergoing surgery, 22 cases were successful in recanalizing the occlusion vessel; 4 cases were failed to open due to the guidewire was difficult to pass through the occlusion segment, of which one case was occluded at the C6 segment of the internal carotid artery, two cases were occluded at the segment of the intracranial vertebral artery, and one case was occluded at the basilar artery. There were 2 cases with complications during the operation, both of which were asymptomatic peripheral embolism, and there were no complications of bleeding and death during the perioperative period. The median follow-up time in 22 successful patients was 12 (3, 21) months. There were no deaths or losses to follow-up. The median mRS score was 1 (1,3). There were no recurrent stroke or transient ischemic attacks. Two cases of asymptomatic in-stent restenosis occurred without adverse reactions and adverse consequences. Four failed patients had a median follow-up time of 11 (3, 18) months. There were no deaths or losses to follow-up. The median mRS score was 2(2, 3). There were 1 case of recurrent stroke and 2 cases of transient ischemic attacks, respectively. Conclusions For patients with symptomatic occlusion of the large intracranial artery in non-acute stage, It is safe and feasible with angioplasty for selected patients guided by HR-MRI to evaluate the occlusion length, pathological nature and latent space of the occlusion segment, and combined with other clinical conditions, which can improve the short-term outcomes of patients' ischemic symptoms and reduce the rate of recurrent stroke. However, the long-term efficacy needs to be confirmed with long-term follow-up.

Imaging evaluation of internal carotid artery occlusion / 中国脑血管病杂志

Internal carotid artery occlusion (ICAO) can be caused by a variety of causes, which presents diverse clinical manifestations in patients ranging from asymptomatic to acute severe stroke syndromes. This extreme variability and the risks of recurrent stroke depend on the various vascular risk factors, including the characteristics of occlusion, hemodynamic alterations, and collateral circulation. A variety of imaging techniques is throughout the process of diagnosis and treatment in patients with ICAO, which plays a vital role. This article aims to review various imaging methods for the evaluation of internal carotid artery occlusion and collateral circulation.

Multi-mode images to assess posterior circulation ischemic stroke caused by bilateral vertebral artery dissection based on vascular ultrasound: A case report / 中国脑血管病杂志

The etiology of posterior circulation ischemic stroke caused by bilateral vertebral artery dissection ( VAD) is often difficult to detect. In this study, the authors report a case of posterior circulation ischemic stroke with a history of excessive back elevation of the neck. The dissection of bilateral vertebral arteries was detected by carotid Doppler ultrasonography and further confirmed by magnetic resonance imaging and high-resolution magnetic resonance imaging. After 6 months of standard administration of dual antiplatelet therapy, recanalization of the bilateral vertebral artery was achieved. It proves that the early diagnosis and standardized medical treatment of VAD can significantly improve patients' prognosis.

Progress in the role of high resolution magnetic resonance imaging technology in the risk assessment of intracranial aneurysm rupture / 中南大学学报(医学版)

The traditional classification, diagnosis, and treatment of intracranial aneurysms are based on the characteristics of their vascular lumen. However, in the past few years, some advances in MRI technology with high-resolution imaging can assess the pathology of intracranial vascular walls. Compared with traditional methods of computed tomography angiography, magnetic resonance angiograhpy, and digital subtraction angiography, high resolution magnetic resonance imaging technology can help us to newly understand the disease by directly evaluating the characteristics of vascular wall, such as aneurysm wall thickness, inflammation, enhancement, permeability and hemodynamics. At present, high-resolution magnetic resonance imaging is increasingly used in clinic to assess the rupture risk of intracranial aneurysms, which is of great significance for guiding the diagnosis and treatment of intracranial aneurysms.

Intracranial atherosclerosis in ischemic stroke with posterior circulation: A high-resolution magnetic resonance imaging study / 中国脑血管病杂志

Objective: To explore the characteristics of intracranial atherosclerosis and possible pathogenesis of posterior circulation ischaemic stroke by 3. 0 T high-resolution magnetic resonance imaging. Methods: The imaging and clinical features of intracranial atherosclerosis in 21 patients with posterior ischemic symptoms admitted in the Department of Neurology of Hebei General Hospital from December 2016 to December 2018 were retrospectively analyzed. The recruited patients were divided into the posterior circulation ischemic stroke group(10cases and 45 plaques) and the non-stroke group(11 cases and 25 plaques) according to their clinical symptoms, signs and imaging manifestations. Clinical data of all patients were collected, and high-resolution 3D time-of-flight MR angiography was used to evaluate the degree of vascular stenosis. Also, plaque characteristics including burden, enhancement, hyperintensity and morphology were counted on high-resolution Tl weighted imaging axial images. Results: The The proportion of diabetes was significantly different between the two groups (P = 0. 024). There were no significant differences in age, sex, smoking, alcohol consumption, hypertension, hyperuricemia, hyperlipidemia, hyperhomocysteinemia, stroke history and history of coronary atherosclerotic heart disease between the two groups (all P > 0. 05). The plaque burden in the posterior circulation ischemic stroke group was higher than that in the non-stroke group ([4. 5 ±1.6] vs. [2. 3 ±1.6]) with significant difference (t = 3. 190, P = 0.005). Plaque enhancement between the two groups was significant different (40.0% [18/45] vs. 16. 0% [4/25], X2 =4. 295, P = 0. 038). There was no significant difference in plaque high signal and plaque morphology between the two groups(all P > 0. 05). Conclusion: Patients in the posterior ischemic stroke group had a higher prevalence of diabetes, and intracranial atherosclerotic plaque burden and plaque enhancement were more common, suggesting that the posterior ischemic stroke group had a higher vulnerability of plaque.

Application of vessel wall magnetic resonance imaging in intracranial artery dissection / 中国脑血管病杂志

Intracranial artery dissection is rare in the clinic, but could account for a large proportion of young patients with intracranial vascular diseases. High-resolution magnetic resonance imaging is a direct method of vessel wall imaging and widely used in clinical practice due to advantages including high spatial resolution, high signal-to-noise ratio and strong reproducibility. The article briefly introduces the typical findings of intracranial artery dissection in high-resolution magnetic resonance imaging and the unique advantages of features such as intimal flap, double-lumen, lumen diameter change and intramural hematoma. It makes up for the deficiency of traditional lumen imaging in the diagnosis and differential diagnosis of intracranial artery dissection, providing a strong basis for the diagnosis and intervention of intracranial vascular dissection.

Development of researches in intracranial atherosclerosis based on the high-resolution magnetic resonance imaging / 中国脑血管病杂志

Intracranial atherosclerosis (ICAS) is a common cause of ischemic stroke. The symptomatic ICAS is closely associated with frequent stroke recurrence, while the asymptomatic ICAS has evidently higher risk of future stroke onset. High-resolution magnetic resonance imaging is regarded as a significant emerging method. In addition to non-invasive identification of intracranial artery stenosis causes, accurate stroke mechanism judgment and plaque stability evaluation, it has great advantages and clinical value in observing the dynamic evolution of lesions and characteristics of perforating arteries, evaluation of drug efficacy and guidance of intravascular treatment of intracranial artery stenosis. The article aims to review the recent development of researches in the mentioned aspects.

Pathogenesis analysis of isolated ischemic stroke in basal ganglia by high resolution-magnetic resonance imaging / 第二军医大学学报

Objective To investigate the pathogenesis of isolated ischemic stroke in basal ganglia using high resolution-magnetic resonance imaging (HR-MRI). Methods Fifteen consecutive patients with isolated ischemic stroke in basal ganglia, who received HR-MRI examination in our hospital between Jan. 2015 and Dec. 2016, were included in this study, and the clinical and imaging data were analyzed. Results Vascular evaluation results showed that 6 patients had normal middle cerebral artery, 4 had mild stenosis, 2 had moderate stenosis, and 3 had severe stenosis. HR-MRI examination showed that plaque formation of the middle cerebral artery in the lesion side was found in 10 patients, of which 7 patients had arc plaques and 3 had annular plaques. T1 weighted imaging showed that the plaques of 8 patients were obviously enhanced, the plaque of 1 patient was moderately enhanced, and the plaque of 1 patient was not enhanced. Conclusion The etiology of isolated ischemic stroke in basal ganglia is complex. HR-MRI examination can clearly show the wall and plaque of the middle cerebral artery, providing evidence for etiological judgment.

High-resolution MRI imaging in patients with middle cerebral artery stenosis / 医疗卫生装备

Object To compare images of the vessel wall between symptomatic and asymptomatic atherosclerotic plaques of the middle cerebral artery (MCA) using high resolution magnetic resonance imaging (HR MRI).Methods HR MRI data were acquired in 36 patients with MCA atherosclerotic stenosis (≥50％) confirmed by MRA, CTA, of whom, 25 symptomatic patients and 11 asymptomatic ones were enrolled into a symptomatic group and an asymptomatic group respectively. The wall thickness and cross-sectional area of stenotic segments were measured and compared between the two groups. The data were analyzed by SPSS 17.0 statistical software.Results The cross-sectional area in the symptomatic group was (3.04±1.03)mm2,while the asymptomatic group was (3.28±0.96)mm2, and the difference between the two groups was not statistically significant (P>0.05). The symptomatic group had a larger wall thickness ((2.32±0.61)mm) when compared with the asymptomatic group ((2.10±0.77)mm), and higher prevalence of plaque enhancement after contrast injection (83.3％).Conclusion Different vessel wall properties on HR MRI are observed between symptomatic and asymptomatic MCA stenosis. Symptomatic MCA stenosis has a larger wall thickness and higher prevalence of plaque enhancement after contrast injection when compared with the asymptomatic.

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.

Intracranial atherosclerotic plaque enhancement associated with ischemic stroke: a study with three-dimensional high-resolution magnetic resonance vessel wall imaging / 复旦学报（医学版）

Objective To evaluate the reproducibility of three-dimensional high-resolution magnetic resonance imaging (HR-MRI) for vessel wall in demonstration of intracranial atherosclerotic plaque enhancement and to explore the relationship between plaque enhancement and ischemic stroke.Methods Fifty-two patients with ischemic stroke underwent traditional head MRI,three-dimensional time of flight magnetic resonance angiography and HR-MRI on a 3.0 T MRI scanner.Each identified intracranial plaque was classified as either culprit (the only or most stenotic lesion upstream from a stroke) or non-culprit (not the most stenotic lesion upstream from a stroke or not within the vascular territory of a stroke).The degree of plaque enhancement was graded by two independent radiologists.The degree of plaque enhancement and luminal stenosis were compared between the culprit group and the non-culprit group by using Mann-Whitney U test.Binary logistic regression analysis was performed to assess the relation between the degree of plaque enhancement and culprit plaques.Results Total 118 plaques were identified in 52 patients with ischemic stroke (52 culprit plaques and 66 non-culprit plaques).The degree of enhancement was rated as strong,moderate and none in 40,9 and 3 culprit plaques,and in 4,24 and 38 non-culprit plaques.Both intra-observer and inter-observer agreement were high for identification of plaque enhancement (kappa＞ 0.75).For culprit plaques group,the degree of plaque enhancement(Z =-7.787,P＜0.01) and luminal stenosis (Z =-5.327,P＜0.01) were significantly higher than those in the non-culprit group.Binary logistic regression analysis revealed that strong enhancement of plaques was independently associated with culprit plaques (OR:74.3,95％CI:15.0-367.1,P＜0.01).Conclusions Three-dimensional HR-MRI detects enhancement of intracranial plaques with high reproducibility.Enhancement is more common in culprit plaques and is associated with the likelihood of ischemic stroke.

Evaluating the relationship between intracranial atherosclerotic plaque stability and stroke recurrence risk with high-resolution MRI / 中国脑血管病杂志

Objective To investigate the relationship between intracranial atherosclerotic plaque stability and stroke recurrence risk.Methods Forty-eight patients with acute ischemic stroke caused by intracranial atherosclerosis in Guangdong Province Hospital of TCM were analyzed retrospectively.After the Essen Stroke Risk Scale (ESRS) was used to assess the risk factors for the patients,they were divided into either an ESRS ≥3 group (n=21 in the high-risk recurrence group) or an ESRS <3 group (n=27 in the low-risk recurrence group).Both groups of patients underwent high-resolution MR imaging (HR-MRI) examinations of the intracranial guilty vessels (basilar artery or unilateral middle cerebral artery).According to the signal intensity of HR-MRI on the T1-weighted imaging,T2-weighted imaging,and T1 fat suppression sequences,the intracranial atherosclerotic stable plaques and unstable plaques were distinguished.The stabilization of intracranial atherosclerotic plaques was compared in patients of both groups.Results There were significant differences in the age and incidences of hypertension,diabetes mellitus,and unstable plaques in patients of both groups (P<0.05).Further multivariate logistic regression analysis of the four factors showed that the age,hypertension,diabetes,and intracranial atherosclerotic unstable plaques were the high-risk factors for recurrent ischemic stroke (ORs,87.114,159.423,8.942,and 11.551,respectively;95%CIs 4.218-1 799.078,3.235-7 855.957,1.054-75.857,and 1.011-132.043,respectively;all P<0.05).Conclusion In addition to the traditional risk factors such as age,hypertension,and diabetes,the intracranial atherosclerotic unstable plaque is an independent risk factor for high-risk recurrence of ischemic stroke.

Changes of high-resolution magnetic resonance imaging before and after Wingspan stent in patients with intracranial large artery stenosis / 中国脑血管病杂志

Objective To evaluate the imaging changes of the arterial wall and lumen at the site of intracranial large artery lesions with high-resolution magnetic resonance imaging (HR-MRI) before and after Wingspan stent implantation.Methods From December 2013 to December 2014,9 patients with symptomatic intracranial arterial stenosis (stenosis rate:70%-99%) admitted to the Department of Interventional Neuroradiology,Xuanwu Hospital,Capital Medical University were enrolled retrospectively.The sites of the lesions included middle cerebral arteries,basilar artery,and intracranial segment of vertebral artery.Head 3D HR-MRI technique was used to analyze and compare the changes of the tube-wall enhancement areas in the lesion sites through image registration and matching.The consistency of stenosis rates measured by HR-MRI and DSA was compared through Pearson correlation analysis and Bland-Altman Plot.Results The success rate of technique was 100% without related complications.(1) After Wingspan stent implantation,the gadolinium enhancement in the vascular walls of the stenosis sites was decreased significantly compared with that before procedure.The area of enhancement decreased was 87±16% after stent implantation compared with before implantation,and the difference was statistically significant (t=2.325,P=0.049).(2) Before stent implantation,the mean stenosis rates of the HR-MRI and DSA measurements were 82±6% and 82±8% respectively,and the difference was not statistically significant (t=0.051,P=0.961);after procedure,the mean stenosis rates of HR-MRI and DSA measurements were 16±12% and 21±12% respectively,and the difference was not statistically significant (t=1.345,P=0.216).(3) The Pearson correlation coefficients of HR-MRI and DSA for stenosis rate measurement before and after stent implantation were 0.347 (P=0.361) and 0.545 (P=0.129) respectively.Bland-Altman statistical images showed that most of the data points were within the consistency limit (x-±1.96 s).Conclusions As an in vivo noninvasive imaging means,HR-MRI can be used to assess the changes of vascular walls of the lesion sites,the vascular lumen,and the original plaques after the intracranial stent release.It can also be used to evaluate the reconstruction of intracranial arterial walls.

Roles of high-resolution magnetic resonance imaging in the diagnosis and treatment of vertebrobasilar dissecting aneurysms / 中国脑血管病杂志

Objective To investigate the roles of high-resolution magnetic resonance imaging (HR-MRI) in the diagnosis and treatment of vertebrobasilar dissecting aneurysms (VBDA).Methods From January 2016 to December 2016,62 patients with VBDA admitted to Xuanwu Hospital,Capital Medical University using 3.0 T HR-MRI (3D-TOF-MRA,3D-T1WI,and 3D-T1WI+C sequence) and diagnosed by DSA were analyzed retrospectively.They were divided into either an asymptomatic group (n=18) or a symptomatic group (n=44) according to their medical histories.Their clinical features,imaging features,and the relationship with prognosis were analyzed.Results HR-MRI revealed that the double lumen sign/intimal flap accounted for 27.8% (n=5) and 54.5% (n=24) respectively in the asymptomatic group and symptomatic group.The intramural hematoma accounted for 22.2% (n=4) and 43.2% (n=19) respectively in both groups.The enhancement of aneurysmal wall accounted for 33.3% (n=6) and 77.3% (n=34) in the asymptomatic group and symptomatic group.There were significant differences in the above features between the two groups (all P<0.05).In the symptomatic group,18.2% (n=8) of patients had aneurysm recurrence,which was significantly higher than the asymptomatic group (5.6%,n=1).The difference between the two groups was statistically significant (P<0.05).Conclusions HR-MRI can better reveal the lesion characteristics of VBDA.The rates of aneurysmal wall enhancement and recurrence in symptomatic VBDAs are higher,which indicates that HR-MRI can assess the stability of the aneurysmal wall and identify the prognosis to a certain extent.

Application value of high-resolution magnetic resonance imaging in the etiological diagnosis of head and neck artery occlusion / 中国脑血管病杂志

Objective To discuss the value of high-resolution magnetic resonance imaging (HR-MRI) in the etiological diagnosis of patients with head and neck artery occlusion.Methods From December 2015 to February 2017,25 consecutive patients with acute head and neck artery occlusion in Xuanwu Hospital,Capital Medical University were enrolled prospectively.The 32-channel head-neck combined coils were used to conduct head-neck integrated HR-MRI.The characteristics of proximal vascular wall of the occluded vascular segments and the signal features of thrombi in the middle and distal segments of occlusion were analyzed.The evaluation of the occlusive etiology was performed by two neurologists according to the clinical history,laboratory examinations,and imaging examinations of the patients,and the accuracy of conventional lumen imaging and conventional lumen imaging combined with HR-MRI in etiological classification were compared.Results Twenty-five patients with acute head and neck artery occlusion completed HR-MRI examinations.A total of 31 segments of the occluded vessels were diagnosed,and 21 of these were diagnosed with the conventional luminal imaging,30 were diagnosed with the conventional luminal imaging+HR-MRI,including 24 segments of atherosclerotic occlusion (n=19),4 segments of arterial dissecting occlusion (n=4),and 3 segments of arteritis occlusion (n=2).(2) In patients with atherosclerotic occlusion,the eccentric thickening was observed in the proximal wall of occlusive segment;the typical double-lumen or crescent-shaped hyperintense hematoma were observed in occlusive arterial dissection;long-segment annular thickening and enhancement were observed in the segment of arteritis occlusion.(3) The accuracy of the cause classification diagnosis of conventional luminal imaging and conventional luminal imaging+HR-MRI were 67.7% (21/31) and 96.8% (30/31) respectively (P<0.01).Conclusions Compared with the luminal imaging,the head and neck combined HR-MRI can reveal the arterial wall characteristics of the initial segment of occlusion.It has certain advantages in the interpretation of the causes,such as atherosclerosis,arterial dissection and arteritis.

High-resolution MRI identifying the terminal segment of the intracranial vertebral artery fine and atherosclerotic lesions / 中国脑血管病杂志

Objective To evaluate the terminal segment of the intracranial vertebral artery (tICVA) fine and atherosclerotic lesions using high-resolution MRI (HRMRI) in order to guide endovascular interventional therapy.Methods From October 2015 to October 2016,4 patients with bilateral tICVA diagnosed with digital subtraction angiography (DSA) and admitted to Xuanwu Hospital,Capital Medical University were analyzed retrospectively.At the same time,time of flight (TOF) and black blood imaging were used.The bilateral tICVA imaging features in 4 patients were analyzed.Congenital dysplasia of vertebral artery and atherosclerotic lesions were identified.Results DSA revealed that bilateral tICVA fine or occlusion.HRMRI evaluation of the vascular wall structure showed that vascular dysplasia in 4 cases were all located on the right sides,showing no obvious thickening of the wall thickness,and the diameter was less than 1/2 of the contralateral side.One patient had atherosclerotic stenosis on the left and 3 had occlusion,showing local wall thickening,plaque formation,and resulting in the narrowing of the corresponding lumen and even occlusion.Three of the patients were treated with endovascular intervention.Conclusion HRMRI is helpful to differentiate hypoplasia in terminal intracranial vertebral artery and atherosclerotic stenosis or occlusion,identifying the dominant side of the vertebral artery and providing image basis for endovascular treatment of vertebral artery.

Effect of evaluation of vertebrobasilar artery atherosclerosis on the progress of posterior circulation ischemia with high-resolution magnetic resonance imaging / 中国脑血管病杂志

Objective To investigate the value of evaluating vertebrobasilar artery atherosclerosis with 3.0 T high-resolution magnetic resonance imaging (HR-MRI) in the progress of posterior circulation transient cerebral ischemia (TIA).Methods From July 2013 to July 2014,30 consecutive patients (outpatients and inpatients) with posterior circulation TIA at the Department of Neurology,the First People's Hospital of Changshu were enrolled respectively.They were all confirmed as the presence of vertebrobasilar atherosclerotic plaques by the head magnetic resonance angiography.The vertebrobasilar artery plaques were examined with 3 T HR-MRI to assess the nature and stability of the plaques.They were randomly divided into either a stable plaque group (n =16) or an unstable plaque group (n =14) according to the results of plaque stability.They were followed up for 24 months.The time and proportion from the first visit to the posterior circulation infarction were recorded and compared between the two groups of patients.Results At the end of follow-up,the time of posterior circulation infarction in the unstable group was significantly shorter than that in the stable group,and the difference was statistically significant (11.5 [7.0,20.0] months vs.24.0[22.5,24.0] months,Z =-2.755,P ＜ 0.05).The ratios of posterior circulation infarction in the stable group and the unstable group were 5/16 and 8/14 respectively.The difference was not statistically significant between the two groups (P ＞ 0.05).Conclusion Evaluating the results of vertebrobasilar artery atherosclerosis plaque with HR-MRI has a certain value for the progression of posterior circulation ischemia disease.

Vascular pathophysiologic characteristics of different types of basilar atherosclerotic infarction / 第二军医大学学报

Objective To use high-resolution magnetic resonance imaging (HR-MRI) for studying the vascular remodeling and plaque characteristics of two types of basilar atherosclerotic infarction; branch occlusive disease (BOD) and nonBOD. Methods Thirty-two patients with symptomatic basilar artery stenosis were divided into BOD and non-BOD groups, with 18 patients in BOD group and 14 in non-BOD group. All the patients received 3. 0T HR-MRI enhancement scanning for the basilar artery wall. The wall thickness and plaque area of steno-occlusive basilar artery at the maximal stenosis were measured and analyzed, so as to assess the vascular remodeling and plaque characteristics. Results HR-MRI scanning showed that the stenosis of non-BOD group was more obvious than that of BOD group ([68. 9 ± 19. 1]% vs [43. 8 ± 18. 8]%, P = 0. 017). Compared with BOD group, positive remodeling wasmore frequently observed in non-BOD (57. 2% vs 16. 7%, P = 0. 036). The wall area index of BOD group was also significantly lower than that of non-BOD group (P<0. 001). Eccentric enhancement was the main form for the two types of basilar atherosclerotic infarction in study, and the plaque enhancements were not significantly different between BOD and non-BOD groups (P = 0. 196); however, the enhancement degree of BOD group was significantly milder than that of the non-BOD group ([39. 9 ± 23. 2]% vs [65. 3 ± 21. 1]%, P=0. 004). Conclusion BOD and non BOD have different vascular remodelings and plaque characteristics.