Clinical Application Of High Resolution Magnetic Resonance Imaging For Intracranial Artery In Patients With T2DM Complicated With Ischemic Stroke

Purpose:High resolution magnetic resonance imaging(HR-MRI)including 3D T1-VISTA sequence was used to observe the structure of intracranial arterial wall,To investigate the application value of HR-MRI for intracranial artery wall imaging in patients with type 2 diabetes mellitus(T2DM)complicated with ischemic stroke.Methods:Clinical data of 149 patients with ischemic stroke or transient ischemic attack(TIA)in our hospital from May 2015 to January2017 were collected.A Philips Achieva 3.0 T MRI scanner with an8-channel head coil was used for examination of intracranial vessels,by using HR-MRI sequences including 3D T1-VISTA,DWI(b=0 mm~2/s and 1000 mm~2/s),3D-TOF MRA,high definition T2WI,axial T1W-SE,T2W-TSE.Multi planar reconstruction of T1-VISTA sequence was done on the MRI Systems workstation(Achieva Release 2.6.3.5).The reconstruction regions of middle cerebral artery(MCA)were chosed at the M1 segment of the MCA,which is 10 mm near to the origin of anterior cerebral artery,and the reconstruction region of basilar artery(BA)was chosed at the position of BA,which is 10mm near to the origin of the superior cerebellar artery.Some cases were excluded,because the poor image quality or scanning level tilt which might lead to unsatisfactory data measurement,and a total of 81 patients were included in the final analysis of the image data.The wall parameters of bilateral MCA and BA were measured,including vascular area(VA),lumen area(LA),wall area(WA),WA/LA ratio and standardized wall index(NWI).IBM SPSS 22software was used to analyze and compare the difference of the the wall parameters between the T2DM group and non-T2DM group.Results:Finally,the location and thickness of plaques in bilateral MCA M1 segment,BA,bilateral PCA P1 segment were analyzed in 81patients.A total of 34 plaques(MCA 19 cases,BA 11 cases,PCA 4 cases)were found.Plaque thickness ranged from 0.6 mm to 3 mm,the average thickness was 1.530±0.560 mm.The MCA plaques were slight frequently located at the inferior wall than at the superior wall of vessel.BA plaques were mostly located at the left wall of vessel,followed by the dorsal wall.Plaques showed more equal signal and slightly higher signal on the T1-VISTA sequence,and showed more mixed signal on the high definition T2WI sequence.A small number of plaques can be seen fiber cap and lipid core on the high definition T2WI.Very few plaques can manifest intraplaque hemorrhage on the T1-VISTA and the high definition T2WI sequence.The study found that 17 patients with a total of20 intracranial arterial thrombus,14 in the anterior circulation,6 in the posterior circulation,most of thrombus in anterior circulation located at M1 segment of MCA.Thrombus showed high signal on the T1-VISTA and mixed high signal on the high definition T2WI,3D-TOF MRA failed to display thrombus.The T1-VISTA and 3D-TOF MRA images of 81patients were compared,T1-VISTA exhibited 6 cases of small atherosclerotic plaques,but 3D-TOF MRA showed normal or suspicious stenosis.In comparison between T2DM group and non-T2DM group,the differences of WA,WA/LA ratio,NWI in right MCA and WA,NWI in left MCA and VA,WA in BA were statistically significant(P<0.05),WA in both bilateral MCA and BA show the significant difference(P<0.05).Conclusion:1)3D T1-VISTA can clearly show the intracranial arterial wall detail through any plane reconstruction,can display small atherosclerotic plaques,which could not be displayed on the 3D-TOF MRA,but the ability to identify the signal within the plaque of 3D T1-VISTA cannot compete with the high definition T2W,the two magnetic resonance sequences are complementary to each other.2)3D T1-VISTA,the high definition T2W can both clearly show intracranial arterial thrombus,thromboses were more likely to occur in the anterior circulation,most of thrombus in the anterior circulation located at M1segment of MCA.3)The bilateral MCA and BA showed greater WA on the 3D T1-VISTA,indicating that T2DM patients were more likely to have intracranial artery wall thickening,which could more easily lead to ICAD.4)LA in BA of T2DM group and non T2DM group was similar to each other,T2DM group had greater VA and WA,which indicated that the BA vessel wall of T2DM group had outward expansion,suggesting that BA in T2DM group might be more likely to have positive remodeling.5)High Resolution MRI including 3D T1-VISTA sequence can be used in diagnosis of ICAD associated with T2DM,which is helpful for clinical early detection,early diagnosis,early treatment,and has broad clinical application prospects.