High-resolution Magnetic Resonance Imaging Reveals Hidden Etiologies of Symptomatic Vertebral Arterial Lesions

• Published in: Journal of stroke and cerebrovascular diseases Vol. 23; no. 2; pp. 293 - 302
• Main Authors: Chung, Jong-Won, Kim, Beom Joon, Choi, Byung Se, Sohn, Chul Ho, Bae, Hee-Joon, Yoon, Byung-Woo, Lee, Seung-Hoon
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2014
• Subjects: Acute stroke; Adult; Aged; Aged, 80 and over; Angiography, Digital Subtraction; Atherosclerosis - complications; Atherosclerosis - diagnosis; Atherosclerosis - pathology; Atherosclerosis - therapy; Cardiovascular; Cerebral Angiography - methods; Diffusion Magnetic Resonance Imaging; Female; Humans; imaging; Magnetic Resonance Angiography; magnetic resonance imaging; Male; Middle Aged; Neurology; plaque; Plaque, Atherosclerotic; posterior circulation; Predictive Value of Tests; Prognosis; Risk Factors; Stroke - diagnosis; Stroke - etiology; Stroke - pathology; Stroke - therapy; vertebral artery; Vertebral Artery - diagnostic imaging; Vertebral Artery - pathology; Vertebral Artery Dissection - complications; Vertebral Artery Dissection - diagnosis; Vertebral Artery Dissection - pathology; Vertebral Artery Dissection - therapy; magnetic resonance imaging; plaque; vertebral artery; imaging; posterior circulation; Acute stroke
• ISSN: 1052-3057; 1532-8511; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2013.02.021

Symptomatic intracranial vertebral artery (VA) disease has various clinical features and poor neurological outcomes. The disease is believed to result from atherosclerotic stenosis, occlusion, or spontaneous VA dissection. The underlying histopathology of symptomatic intracranial VA disease has only been studied at postmortem, and no in vivo imaging investigation has been conducted despite the increased sophistication of imaging techniques. The authors performed high-resolution magnetic resonance imaging (HR-MRI) of intracranial vertebral arteries in 9 patients, suspected of a VA pathology by magnetic resonance imaging (MRI), magnetic resonance angiography, and digital subtraction angiography. HR-MRI allowed the authors to determine the following: (1) atherosclerotic plaque is composed of a large lipid core with intraplaque hemorrhage and calcification, (2) nonstenotic atherosclerosis exhibits diffuse vessel wall thickening and plaque protruding toward perforating arteries, and (3) spontaneous VA dissection exhibits large intramural hematoma in a false lumen with complete occlusion of the true lumen. In addition, VA hypoplasia was easily differentiated from atherosclerotic stenosis, by direct visualization of a narrow lumen diameter without arterial wall thickening. Furthermore, etiologic diagnoses based on classical MRI, angiography, and digital subtraction angiography were changed in 3 patients after HR-MRI. Additional information on plaque stability, indicating the possibility of unstable plaque, was found in 4 patients. The application of HR-MRI in stroke patients with VA pathologies enabled the authors to determine the underlying pathophysiologies. These findings could be used to improve risk stratification and treatment decision making in symptomatic intracranial VA disease.