Role of Vessel Wall Magnetic Resonance Imaging in the Diagnosis of Intracranial Vasculopathies.

Background: Stroke is a leading cause of death and disability worldwide, affecting millions annually. Accurate etiological diagnosis is critical for the effective treatment and prevention of recurrent strokes. Traditional luminal imaging techniques like computed tomography (CT) and magnetic resonance angiography (MRA) provide limited information, focusing solely on vessel lumen characteristics. Vessel wall magnetic resonance imaging (VW-MRI) has emerged as a valuable non-invasive technique for evaluating intracranial vasculopathies with high spatial resolution. It also helps in identifying plaque composition and distinguishing between lipid-rich, fibrous, calcified, and thrombotic components. This information is crucial for assessing plaque vulnerability and predicting the risk of future cardiovascular events.

Objectives: This study aimed to evaluate the findings of VW-MRI among cases having suspicious stenosis detected on MRA and to characterize atherosclerotic plaque vulnerability features on VW-MRI.

Methods: This cross-sectional hospital-based study was conducted at the Department of Radiodiagnosis, Sawai Man Singh (SMS) Medical College and Hospital, Jaipur, on 45 patients who met the inclusion criteria. Participants who showed suspicious stenosis on conventional MRA underwent VW-MRI using a 3T GE Signa Architect 64-channel MRI machine (GE HealthCare, Chicago, IL, USA) to obtain vessel wall MR sequences: 3D Ax time-of-flight (TOF) fat-suppressed spoiled gradient recalled echo (SPGR) Fs, 3D Sag T2 Cube, 3D Sag T1 black-blood (BB) Cube Fs, 3D Sag T1 magnetization-prepared rapid gradient-echo(MP-RAGE), and 3D Sag T1 BB Cube Fs +C. These sequences will be taken to differentiate between intracranial atherosclerotic plaque, vasculitis, and moyamoya disease/pattern and also to characterize atherosclerotic plaque vulnerability features. Data were collected through a structured questionnaire and magnetic resonance imaging (MRI) results, followed by statistical analysis.

Results: The majority (50%) of patients were middle-aged, with a mean age of 48 years. Atherosclerosis was the most common (67%) diagnosis, followed by central nervous system (CNS) vasculitis (22%) and moyamoya disease (11%). VW-MRI detected significant VW abnormalities in all cases as compared to MRA which detected only 73.35% of cases. Positive remodeling was associated with CNS vasculitis and vulnerable plaques, while moyamoya disease was linked to negative remodeling.

Conclusion: VW-MRI proves superior to traditional luminal imaging for diagnosing intracranial vasculopathies. It enhances the understanding of VW abnormalities, aiding in the management of stroke and other cerebrovascular diseases.