Comparison of non-contrast vessel wall imaging and 3-D time-of-flight MRA for atherosclerotic stenosis and plaque characterization within intracranial arteries - 22/06/19

Doi : 10.1016/j.neurad.2019.05.003

Dong Kun Kim ^a,^⁎ , Jared T. Verdoorn ^a , Tina M. Gunderson ^b , John Huston III ^a , Waleed Brinjikji ^a,^c , Giuseppe Lanzino ^c , Vance T. Lehman ^a
^a Department of Radiology, Mayo Clinic, 200, First St. SW, 55905 Rochester, MN, United States
^b Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
^c Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States

^⁎Corresponding author.

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Graphical abstract

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Highlights

•	VWI has reasonable sensitivity (92.5%) and specificity (82.1%) for luminal narrowing and diameter assessment of the intracranial arteries compared to 3D-TOF.
•	3D-TOF has relatively limited sensitivity (59.4%) for identification of areas of plaques compared to VWI.
•	Mean intra-rater differences in diameter measurements between VWI and 3D-TOF, and mean inter-rater differences in luminal measurements for VWI ranged from 0.02 mm to 0.35 mm (SD 0.49–0.66 mm), corresponding to good to excellent agreement.
•	VWI without gadolinium can be used for simultaneous luminal stenosis and atherosclerotic plaque assessment of the major intracranial arteries.

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Abstract

Purpose

We compared the ability of intracranial high-resolution vessel wall imaging (VWI) without gadolinium and 3-D time-of-flight (3D-TOF) MRA techniques to characterize intracranial arterial stenosis and arterial wall plaque consistent with atherosclerotic plaque.

Methods

Consecutive intracranial VWI examinations performed within 2 months of a 3D-TOF exam with at least 1 noted plaque was included. Examinations assessed 17 vessel segments for plaque and diameters of stenotic and normal segments using double oblique reformatted images. Results were compared with the VWI and 3D-TOF exams considered the reference standard for plaque and luminal stenosis, respectively.

Results

Assessed segments totaled 286 from 17 patients. Proximal segment sensitivity and specificity for luminal stenosis detection with VWI was 92.5% and 82.1%, respectively, whereas for assessing plaque with 3D-TOF it was 59.4% and 98.3%, respectively. The mean intra-rater difference in luminal diameter measurements between VWI and 3D-TOF at normal segments and at the area of maximal stenosis was 0.02mm (SD 0.51mm) and 0.08mm (SD 0.66mm), respectively.

Conclusions

Intracranial VWI demonstrated reasonably high sensitivity and specificity for luminal stenosis assessment using 3D-TOF as a reference standard, while 3D-TOF demonstrated low sensitivity for plaque detection. Our results suggest that VWI can be used for simultaneous assessment of luminal stenosis and plaque in the intracranial arteries.

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Keywords : Vessel wall imaging, Magnetic resonance angiogram, Magnetic resonance imaging, Atherosclerosis

Abbreviations : 3D-TOF