Analysis Of High-resolution Magnetic Resonance Vessel Wall Imaging Studies Of Symptomatic Intracranial Atherosclerotic Plaques

Intracranial atherosclerotic disease(ICAD)is one of the major causes of ischemic stroke and is closely associated with high stroke morbidity and mortality.To date,the incidence of stroke induced by ICAD in China has exceeded that of other countries,and ischemic stroke of the large intracranial atherosclerotic type has a higher incidence,disability,recurrence and mortality than other stroke subtypes.Early and accurate assessment of intracranial atherosclerotic plaque characteristics is of paramount importance.High-resolution magnetic resonance vessel wall imaging(HRMR-VWI))has become an important imaging method to observe the intracranial arterial wall,which can clearly display the structure and characteristics of the vessel wall and lesions such as atherosclerotic plaques,and directly visualize the vessel wall,enabling detailed assessment of plaques.Objective:3.0T HRMR-VWI was used to analyze the distribution,morphological features and vulnerability of intracranial arterial plaques for early identification and further analysis of imaging features of high-risk plaques,which can be used as imaging indicators to assess the risk of stroke recurrence and provide imaging support for identification of vulnerable plaques and prediction of stroke recurrence and clinical symptoms.Methods:1.One hundred and thirteen patients between September 2020 and January 2023,aged 25-80 years,who were admitted to our neurology and neurosurgery departments and met the inclusion and exclusion criteria and had only a single responsible vessel in the five intracranial arteries studied(basilar artery,left middle cerebral artery,right middle cerebral artery,left intracranial segment of the vertebral artery,and right intracranial segment of the vertebral artery)were selected.The patients were divided into 3 groups according to the modified m RS score(taking the first 3 levels),namely,group 1(score 0′: 37 patients),group 2(score 1′: 38 patients),and group 3(score 2′: 38 patients),and the differences in general clinical data,intracranial arterial plaque distribution location,vulnerable plaque detection rate and vulnerable component detection rate among the 3 groups were analyzed to analyze the differences affecting the m RS score grouping(i.e.,severity of symptoms)independent risk factors.2.The patients were divided into stable(48 patients)and unstable(65patients)groups according to the enrolled patients and the plaques were determined as stable or unstable plaques by HRMR-VWI analysis,and the independent risk factors affecting the stability of intracranial arterial plaques were analyzed.The differences in vascular remodeling pattern,risk of stroke recurrence,degree of luminal stenosis and distribution location of intracranial arterial plaques between the 2 groups were analyzed.Results:1.The differences in age,smoking,hypertension,homocysteine,total cholesterol and triglycerides among the basic clinical data of the three groups based on m RS score were statistically significant(P<0.05),but the differences in the rest of the basic data were not statistically significant(P>0.05).The differences in the detection rates of vulnerable plaques between groups 1 and 3,groups 2 and 3,and groups 1 and 3 were statistically significant(P<0.05),and the detection rates of vulnerable plaques became higher with the increase of m RS score grade.the differences in the detection rates of vulnerable components such as intra-plaque hemorrhage(IPH),lipid rich necrotic core(LRNC),thin or ruptured fibrous cap(TRFC),and active inflammation were statistically significant between the 3 groups(P<0.05),and the higher the m RS The higher the score grade(i.e.,the more severe the degree of clinical symptoms),the higher the percentage of vulnerable components.Among them,IPH(OR=3.785,95%CI: 1.563 to 9.164)and active inflammation(OR=2.335,95% CI: 1.033 to5.278)were independent risk factors for exacerbation of patients’ symptoms,and the risk of IPH was higher than that of active inflammation.2.In the baseline data of the stable and unstable groups,male,hypertension,diabetes mellitus,smoking,alcohol consumption,body mass index(BMI),ghrelin and fasting glucose were higher in the unstable group than in the stable group,and the difference was statistically significant(P<0.05),in which smoking(OR=0.338,95% CI: 0.120-0.953)and hypertension(OR=0.362,95% CI: 0.143-0.915)were independent risk factors for plaque instability.The difference in remodeling pattern and risk of stroke recurrence between the 2 groups was statistically significant(P<0.05),with negative vascular remodeling predominating in the stable group and positive vascular remodeling in the unstable group;the risk of stroke recurrence was higher in the unstable group.There was no statistically significant difference in stenosis and plaque distribution location between the2 groups(P>0.05).Conclusions:1.Qualitative analysis of intracranial atherosclerotic plaque components by 3.0T HRMR-VWI and assessment of plaque stability can predict the risk of ischemic stroke recurrence early.Smoking and hypertension are independent risk factors for plaque instability,with hypertension having a higher risk than smoking.2.Vulnerable plaque is an important factor contributing to increased m RS scores(i.e.,worsening of symptoms)in patients.Plaque vulnerable components IPH,LRNC,TRFC and active inflammation were correlated with increased m RS scores,with IPH and active inflammation being independent risk factors for symptom exacerbation in stroke patients.3.The comparison of luminal stenosis of stable plaques with that of unstable plaques further confirms that luminal stenosis is not a reliable indicator to evaluate plaque stability,but the vulnerability of the plaque itself is more important.Positive remodeling usually suggests vulnerable plaques,while negative remodeling suggests stable plaques.