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Original article
Perfusion and plaque evaluation to predict recurrent stroke in symptomatic middle cerebral artery stenosis
  1. Jinhao Lyu1,
  2. Ning Ma2,
  3. Chenglin Tian3,
  4. Feng Xu4,
  5. Hang Shao4,
  6. Xin Zhou5,6,
  7. Lin Ma1,
  8. Xin Lou1
  1. 1 Department of Radiology, Chinese PLA General Hospital, Beijing, China
  2. 2 Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
  3. 3 Department of Neurology, Chinese PLA General Hospital, Beijing, China
  4. 4 Automation Department, Tsinghua University, Beijing, China
  5. 5 State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, Hubei, China
  6. 6 University of ChineseAcademy of Sciences, Beijing, China
  1. Correspondence to Xin Lou; louxin{at}301hospital.com.cn

Abstract

Background and purpose We investigated the baseline demographics of patients with severe unilateral atherosclerotic stenosis of the middle cerebral artery (MCA) using multimodal MRI and evaluated the haemodynamic impairments and plaque characteristics of patients who had a recurrent stroke.

Materials and methods We retrospectively recruited consecutive patients with severe unilateral atherosclerotic MCA stenosis who underwent arterial spin labelling (ASL) with postlabelling delay (PLD) of 1.5 and 2.5 s, and vessel wall MRI. For each PLD, cerebral blood flow (CBF) maps were generated. Hypoperfusion volume ratio (HVR) from 2 PLD CBF was calculated. An HVR value ≥50% was considered as severe HVR. Plaque areas, plaque burden, plaque length and remodelling index were measured. Plaque enhancement at maximal lumen narrowing site were graded. Baseline clinical and imaging characteristics were compared between patients with (event+) and without (event−) 1 year ischaemic events.

Results Forty-three patients (47.23±12.15 years; 28 men) were enrolled in this study. Seven patients had an HVR ≥50%. During the 1-year follow-up, 7 patients had experienced a recurrent stroke. HVR were significantly higher in the event+ than event− (53.17%±29.82% vs 16.9%±15.57%, p=0.0002), whereas no significant difference was detected in plaque areas, plaque burden, remodelling index, plaque length and plaque enhancement grade. The multivariable analysis revealed that a severe HVR was significantly associated with a recurrent stroke (Odds ratio=12.93, 95% confidence interval 1.57 to 106.24, p=0.017) after adjusted by hypertension and smoking.

Conclusion HVR obtained from two PLD ASL may be a useful imaging predictor of recurrent stroke.

  • intracranial atherosclerotic disease
  • arterial spin labeling
  • post labeling delay
  • high-resolution mri
  • stroke mechanism

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/svn-2018-000228

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    Footnotes

    • Contributors Conception and design of the study: XL, NM, LM and XZ. Acquisition and analysis of data: JL, CT, FX and HS. Drafting a significant portion of the manuscript: JL and NM.

    • Funding This work was supported by The National Natural Science Foundation of China (contract grant number:81825012, 81730048, 81671126 to XL and contract grant number: 81471390 to NM).

    • Competing interests None declared.

    • Ethics approval The institutional ethics committee of the two hospitals approved the study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.