Application Of Vessel Wall Magnetic Resonance Imaging In Diagnosis Of Middle Cerebral Artery Stenosis In Youth

ObjectiveThe aim of this study was to investigate the diagnostic accuracy of vessel wall magnetic resonance imaging(VW-MRI)in young patients with middle cerebral artery(MCA)stenosis and explore the feasibility of diagnosis and differential diagnosis of MCA stenosis by VW-MRI.Materials and MethodsVW-MR data of patients suspected with MCA stenosis were collected from September 2015 to February 2018 from Radiology Department,Qilu Hospital of Shandong University.The enrollment criteria were as follows:the patients aged 18-45 years,suspected with ischemia or infarction of MCA blood supply area by doctors of Neurology department,and with MCA stenosis in one or both sides showed on magnetic resonance angiography(MRA).A total of 91 patients were enrolled in the study,excluding those who failed to cooperate with MRI examination or with incomplete medical records and imaging and clinical data were analyzed.The differences of causes of MCA stenosis between imaging diagnosis and final clinical diagnosis and the consistency of the degree of MCA stenosis between VW-MRI and DSA were compared.The imaging features,including involved side(one or both sides),pattern of vessel wall thickening,shape of vessel cavity,degree and pattern of enhancement were analyzed in three groups(ICAD plaque,MMD and cerebral vasculitis)and the comparison was made between each two groups.The relationship between ICAD plaque distribution and symptoms,risk factors and causes of MCA stenosis between female and male patients,were analyzed statistically.SPSS 19.0 statistical software was used.Rank correlation analysis and consistency comparison were performed to compare the coincidence rate of diagnosis between VW-MRI imaging and final clinical diagnosis and coincidence rate of degree of MCA stenosis between VW-MRI and DSA.The Kappa value was calculated.Quantitative data were expressed as mean±standard deviation.The t-test was used to compare quantitative data,and ?2 test was used to compare count data in different groups.The results were statistically significant at P<0.05.Results(1)For the coincidence rate of diagnosis between VW-MRI imaging and final clinical diagnosis,Kappa=0.927 and near-perfect agreement was achieved.For coincidence rate of degree of MCA stenosis between VW-MRI and DSA,Kappa equalled to 0.715,with high consistency.(2)There were significant differences in involved side(one or both sides),pattern of vessel wall thickening,shape of vessel cavity,degree and pattern of enhancement between ICAD and MMD(P<0.05).Significant differences in pattern of vessel wall thickening,shape of vessel cavity,degree and pattern of enhancement were found between ICAD and cerebral vasculitis(P<0.05),but not for involved side(one or both sides)(P>0.05).Significant differences in involved side(one or both sides),pattern of vessel wall thickening,degree of enhancement were found between MMD and cerebral vasculitis(P<0.05),but not for shape of vessel cavity,pattern of enhancement(P>0.05).(3)The percentage of plaques in the upper wall and dorsal wall in ACI group was significantly higher than that in TIA group(P<0.05).(4)ICAD plaque was the most common cause of MCA stenosis in male youth,the causes of MCA stenosis in female patients were widely distributed,and there were significant difference between two groups(P<0.05).Smoking,alcohol consumption and hyperhomocysteinemia in male patients were significantly more common than those in female patients(P<0.05),while abnormalities of rheumatism series were more common in female patients than in male patients(P<0.05).There was no significant difference in age,hypertension,diabetes,dyslipidemia and family history(P>0.05).ConclusionsThe VW-MRI imaging findings,such as pattern of vessel wall thickening,shape of vessel cavity,degree and pattern of enhancement are characteristic in ICAD plaques,MMD and cerebral vasculitis groups and the diagnostic accuracy of VW-MRI diagnosis is high.There is a high degree of consistency between VW-MRI diagnosis and final clinical diagnosis.A high degree of consistency is also observed in judging the degree of MCA stenosis between VW-MRI and DSA.VW-MRI provides a new noninvasive choice for the etiological diagnosis of MCA stenosis and stenosis rate measurement.There is a significant difference in the distribution of ICAD plaques between ACI and TIA group.In ACI group,the percentage of plaques in the upper wall and dorsal wall is significantly higher than that in TIA group.The result indicates that plaques located in upper wall and dorsal wall are more dangerous,and the corresponding measures should be taken in time.ICAD plaque is the most common cause of MCA stenosis in male youth,while the causes of MCA stenosis in female patients are widely distributed.Among the risk factors of ICD,smoking,alcohol consumption and hyperhomocysteinemia in male patients are significantly more common than those in female patients,while abnormalities of rheumatism series are more common in female patients than in male patients.