| Objective:To investigate whether the recent cerebrovascular ischemic events have relation with the enhancement of intracranial plaques and remodeling pattern of intracranial artery.Hence to explore the imaging makers of the intracranial unstable plaques with ICAD patients and to be able to evaluate exactly intracranial plaques with ICAD patients in clinic practice.Since we can make earlier medical trentment strategy in patients with intracranial unstable plaques to decrease the rate of ischemic cerebral infarction.Subjects and Methods:We enlisted 29 patients(acute ischmic stroke n=24,TIA n=5;male n=25,average age n=61.7years±9.8)with intracranial ischemic cerebral event in General Hospital Affiliated Tianjin Medical University were fulfilled the detailed recruited criteria of the study: 1)intracranial large artery stenosis was verified by CTA、MRA or DSA;2)cerebral infarct lesions on DWI or TIA symptom were located within the territory of unilateral stenotic intracranial large artery;3)Intracranial large arteries atherosclerosis were confirmed;4)patients with severe EICA stenosis(stenosis rate50%)who were unilateral with symptom of the ischemic cerebral stroke should be exculded;5)all other potential causes of stroke being entirely excluded.All these Twenty-nine recruited patients underwent 3D time-of-flight MRA,pre and post 3D T1WI-SPACE imaging for intracranial atherosclerotic plaques.Based on infarct lesion located on DWI or the patients’ symptom of TIA,all identitied plaques of 29 recuited patients were classified as either symptom plaques(the only or most stenotic lesion within the territory of a stroke)or non-symtom plaques(not within the upstream from a stroke).Contrast enhancement of plaques were categorized according to 3D T1WI-SPACE imaging(grade 0,enhancement less than or equal to that of normal arterial walls seen elsewhere;grade 1,enhancement greater than grade 0 but less than that of the pituitary infundibulum;grade 2,enhancement greater than or equal to that of the pituitary infundibulum),and rate of contrast enhancement was also calculated.Then lumen area(LA),outer wall area(OWA),and wall area(WA)were measured both at the lesion and reference sites.Plaque burden was counted as WA divided by OWA.The arterial remodeling ratio(RR)was counted as OWA at the lesion site divided by OWA at the reference site.Arterial remodeling pattern was classified as positive if RR>1.05,intermediate if 0.95≤RR≤1.05,and negative if RR<0.95.Results:1.Eighty-one plaques were discovered in 29 patients with acute ischemic cerebrovascular events(29 symptom plaques,52 non-symptom plaques).All 29 symptom plaques enhanced(grade 1,38%,grade 2,62%);21 of 52 non-symptom plaques enhanced(grade,86%,grade 2,14%).Grade 0 was only observed in non-symptom plaques,grade 2 was related with symptom plaques.Plaque rate of enhancement quantified for all 81 plaques showed significant differences between symptom plaques and non-symptom plaques(P<0.001).The rate of enhancement of non-symptom plaques(mean,0.429±0.30)was nearly half that of symptom plaques(mean 0.957±0.33).2.Remolding rate of intracranial artery quantified for all 81 plaques show no significances(P=0.24)between symptom plaques(mean 0.97±0.31)and non-symptom plaques(mean 1.08±0.29.But symptom plaques have a lagre plaque burden than non-symptom plaques(P<0.01).Conclusions:Enhancement of intracranial atherosclerotic plaque can be used to confim vessel lesions responsible for cerebrovascular ischemic events.This feature may represent inflammation and neovascularization of plaque and may serve as a imaging marker of intracranial unstable plaque and provide insight into risk for future events,enabling the identification of patients who have an suspected burden of vulnerable features and who might benefit from preventive therapeutic interventions. |
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