Association Of Combining Characteristics Of Intracranial Atherosclerotic Disease And Cerebral Small Vessel Disease With Acute Ischemic Stroke : A Magnetic Resonance Imaging Study

Part 1 The relationship between the magnetic resonance imaging characteristics of intracranial atherosclerotic and cerebral small vessel diseasesPurposeIntracranial atherosclerosis(ICAS)and cerebral small vessel diseases(CSVD),as two causes of ischemic stroke,affect blood vessels in the brain and often coexist.This study aimed to investigate the correlation between the MRI characteristics of ICAS and CSVD.Materials and MethodsPatients with cerebrovascular symptoms were recruited and underwent magnetic resonance imaging.The intracranial plaque characteristics of all patients,including luminal stenosis,the length of plaque,maximal wall thickness(Max WT),intraplaque hemorrhage(IPH),irregular plaque surface and plaque enhancement,were evaluated.The CSVD characteristics,including enlarged perivascular spaces,white matter hyperintensities(WMHs)and lacunes were also analyzed,and the severity of WMHs was graded using the Fazekas score,the number of enlarged perivascular spaces were graded using a 3-category ordinal scale(0 – 10;10 – 25;>25).Univariate and multivariate Logistic regressions were used to evaluate the association between t the MRI characteristics of ICAS plaque and CSVD,and the odds ratio and corresponding95% CI were calculated.ResultsAmong 194 included patients,121(62.4%)were males,the mean age was62.2±11.7 years old.The prevalence of irregular plaque surface,T1 hyperintense and plaque enhancement was 58.6%(115/194)、 18.8%(37/194)and 59.1%(116/194),respectively.The prevalence of the EPVS,lacunes and WMHs was 48.4%(95/194)、51.5%(101/194)和 63.2%(124/194),respectively.Irregular plaque surface(OR: 0.515;95% CI: 0.287-0.921;P = 0.025)and plaque enhancement(OR: 8.274;95% CI: 4.216-16.236;P < 0.001)were associated with EPVS in univariate analysis.After full adjustment,plaque enhancement(OR: 0.074;95% CI: 0.031-0.175;P<0.001)remained significantly associated with EPVS.Irregular plaque surface(OR: 0.346;95% CI:0.191-0.627;P<0.001)T1 hyperintense(OR: 2.20;95% CI: 1.042-4.730;P = 0.039)and plaque enhancement(OR: 0.362;95% CI: 0.200-0.654;P = 0.001)were associated with LI in univariate analysis.After full adjustment,plaque enhancement(OR: 0.433;95% CI: 0.218-0.858;P=0.016)remained associated with LI.Irregular plaque surface(OR: 0.284 95% CI: 0.153-0.524;P<0.001)and plaque enhancement(OR: 0.531;95%CI: 0.292-0.964;P = 0.038)were associated with WMHs in univariate analysis.After full adjustment,Irregular plaque surface(OR: 0.419;95% CI: 0.211-0.835;P=0.013)was consistently associated with WMHs.ConclusionThe characteristics of ICAS,especially the presence of plaque enhancement,as well as the presence of EPVS,severe WMHs,are independent risk factors for acute cerebral infarction.Part 2 Association of combining characteristics of intracranial atherosclerotic disease and cerebral small vessel disease with acute ischemic strokePurposeIt has been shown that intracranial atherosclerosis disease(ICAD)and cerebral small vessel disease(CSVD)are respectively associated with ischemic stroke.This study aimed to investigate the association of combining the characteristics of ICAD and CSVD with acute cerebral infarct(ACI)in symptomatic patients using magnetic resonance(MR)imaging.Materials and MethodsIn addition to analyzing the MR images in the first part,the presence or absence of acute cerebral infarct on the brain MR images was also analyzed.Univariate and multivariate Logistic regressions were used to evaluate the association between the MRI characteristics of single intracranial plaque,CSVD and the co-existing intracranial plaque and CSVD and ACI: and the odds ratio and corresponding 95% CI were calculated.The receiver operating characteristic(ROC)curve analysis was performed to assess the predictive value of these MR imaging characteristics for ACI.ResultsOf 148 recruited patients(mean age: 57.04±11.00 years;85 males),71(47.97%)were diagnosed as ACI based on MR images.Plaque enhancement(grade=2,odds ratio [OR],4.266;95% confidence interval [CI],1.608-11.319;P =0.004),EPVS(OR: 4.149;95% CI: 2.017-8.532;P <0.001),WMH(OR: 8.053;95% CI: 2.638-24.580;P <0.001)and lacune(OR: 2.593;95% CI: 1.308-5.138;P =0.006)were associated with ACI in univariate analysis.After full adjustment,plaque enhancement(OR: 5.623;95% CI: 1.602-19.743;P =0.007),EPVS(OR: 4.200;95% CI: 1.656-10.650;P =0.003),and WMH(OR: 9.036;95% CI: 1.844-44.268;P =0.007)were still significantly associated with ACI.ROC curve analysis showed that area under the curve of plaque enhancement,EPVS and WMH was 0.640(95% CI: 0.544–0.735),0.670(95% CI: 0.575-0.766)and 0.652(95% CI: 0.558-0.746),and the combination of age,sex,BMI,plaque enhancement,EPVS,and WMH in the diagnosis of ACI was 0.807(95% CI: 0.733-0.881),respectively.ConclusionThe combination of MR imaging characteristics of ICAD and CSVD has a higher predictive value for acute cerebral infarction than measurements of each disease alone.