Recent advances of MRI in diagnosis of cerebral atherosclerotic disease

Abstract

Background: Intracranial atherosclerotic disease (ICAD) is a leading cause of ischemic stroke, often presenting with vessel wall abnormalities that are not detected by conventional imaging techniques. The advent of vessel wall magnetic resonance imaging (VW-MRI) has provided a novel approach to directly visualize and assess these abnormalities, offering potential improvements in diagnosis and patient management.Objective: To evaluate the effectiveness of VW-MRI in the detection and characterization of intracranial vasculopathies, with a focus on differentiating ICAD from other conditions such as reversible cerebral vasoconstriction syndrome (RCVS), vasculitis, and Moyamoya disease.Methods: This prospective study included 150 patients (mean age 51 ± 15.7 years, 62% female) with suspected intracranial vasculopathies, conducted from March 2022 to February 2024 at Benha University Hospital and Al-Gobeal Military Hospital. VW-MRI was used to assess vessel wall morphology, including patterns of thickening, enhancement, and outward remodeling. Imaging findings were compared across the vasculopathy groups.Results: ICAD was identified in 66% (n=99) of patients, with 91.9% exhibiting eccentric wall thickening. In contrast, concentric thickening was predominant in vasculitis (88.5%) and RCVS (77.8%). Significant differences were noted in outward remodeling (P=0.02) and enhancement grading (P=0.008) across the groups. The high-grade enhancement was observed in 78.8% of ICAD lesions, highlighting the utility of VW-MRI in differentiating these conditions.Conclusion: VW-MRI provides crucial insights into the vessel wall pathology of ICAD and other vasculopathies, offering superior diagnostic accuracy over traditional lumen-based imaging. Its ability to distinguish between different types of intracranial vasculopathies underscores its potential as a valuable tool in stroke prevention and management.