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Purpose: To evaluate the clinical performance of a newly developed three-dimensional (3D) intra- and extracranial arterial vessel wall joint imaging technique at 3T using T1-weighted 3D variable-flip-angle turbo spin-echo sequence with improved cerebrospinal fluid suppression in patients with cerebrovascular disease., Materials and Methods: 122 consecutive patients (mean age 45.96 ± 12.16 years) with clinically confirmed cerebrovascular symptoms were imaged using a 3D intra- and extracranial arterial vessel wall joint imaging sequence with and without contrast enhancement on a 3 T MR system. The number of plaques and culprit plaques were evaluated. The image quality score, percent stenosis, remodeling ratio, and plaque burden were measured and compared between intracranial and carotid arterial plaques, and between non-culprit and culprit plaques., Results: Except for 23 patients, there were 322 plaques (111 culprit plaques) detected in 96 patients with large artery atherosclerosis. Of the plaques, 278 (96 culprit plaques) and 44 (15 culprit plaques) plaques were identified in intracranial and extracranial arteries, respectively. Image quality did not differ significantly between pre- and post-contrast vessel wall magnetic resonance images. There were also no significant differences in the percent stenosis, remodeling ratio, and plaque burden between intracranial and carotid arteries, and between non-culprit and culprit plaques. The enhancement rate of culprit plaques was significantly higher than that of non-culprit plaques., Conclusions: The described joint imaging is a promising vessel wall magnetic resonance imaging method for comprehensive diagnosis of cerebrovascular symptoms and investigation of etiology. The imaging technique is a potentially valuable means to optimize treatment., Competing Interests: Declaration of Competing Interest The authors declared that they have no conflicts of interest to this work. We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted., (Copyright © 2020. Published by Elsevier B.V.)

Background and Purpose: Multi-delay arterial spin-labeling (ASL) perfusion imaging has been used as a promising modality to evaluate cerebral perfusion. Our aim was to assess the association of leptomeningeal collateral perfusion scores based on ASL parameters with outcome of endovascular treatment in patients with acute ischemic stroke (AIS) in the middle cerebral artery (MCA) territory., Materials and Methods: ASL data at 4 post-labeling delay (PLD) times (PLD = 1.5, 2, 2.5, 3 s) were acquired during routine clinical magnetic resonance examination on AIS patients prior to endovascular treatment. A 3-point scale of leptomeningeal collateral perfusion grade on 10 anatomic regions was determined based on arterial transit times (ATT), cerebral blood flow (CBF), and arterial cerebral blood volume (CBV), estimated by the multi-delay ASL protocol. Based on a 90-day modified Rankin Scale (mRS), the patients were dichotomized to moderate/good (mRS 0-3) and poor outcome (mRS 4-6) and the regional collateral flow scores were compared., Results: Fifty-five AIS patients with unilateral MCA stroke (mean 73.95±14.82 years) including 23 males were enrolled. Compared with poor outcome patients, patients with moderate to good outcomes had a significantly higher leptomeningeal collateral perfusion scores on CBV (3.01±2.11 vs. 1.82±1.51, p=0.024) but no differences on scores on CBF (2.31±1.61 vs. 1.66±1.32, p=0.231) and ATT (2.67±2.33 vs. 3.42±3.37, p=0.593)., Conclusions: Higher leptomeningeal collateral perfusion scores on CBV images by ASL may be a specific marker of clinical outcome after endovascular treatment in patients with acute MCA ischemic stroke. Further study with larger sample size is warranted.

Background and purposeThree-dimensional pseudocontinuous arterial spin labeling with multiple postlabeling delays has been used to assess cerebral blood flow (CBF). We used this modality to estimate antegrade and collateral flow in patients with unilateral middle cerebral artery stenosis.MethodsConsecutive patients with unilateral middle cerebral artery 50% to 99% stenosis at 2 centers underwent pseudocontinuous arterial spin labeling with a postlabeling delays of 1.5 and 2.5 s. Mean CBF of bilateral middle cerebral artery territory at the postlabeling delays 1.5 and 2.5 s was measured. Early-arriving flow proportion was defined as (CBF 1.5 s at lesion side/CBF 2.5 s at normal side)×100%. Late-arriving retrograde flow proportion was defined as ([CBF 2.5 s-CBF 1.5 s] at lesion side-[CBF 2.5 s-CBF 1.5 s] at normal side)/CBF 2.5 s at normal side×100%. Antegrade and collateral scales were evaluated in patients with conventional angiography. Spearman correlation coefficients were calculated between early-arriving flow and late-arriving retrograde flow proportions on arterial spin labeling and antegrade and collateral scales on conventional angiography, respectively.ResultsForty-one patients (46.0±12.0 years) were enrolled. The mean early-arriving flow proportion was 78.3±14.9%. The mean late-arriving retrograde flow proportion was 16.1±10.2%. In 21 patients with conventional angiography, Spearman correlation coefficient was 0.53 (95% confidence interval, 0.11-0.79) between antegrade grade and early-arriving flow proportion (P=0.01) and 0.81 (95% confidence interval, 0.56-0.92) between collateral grade and late-arriving retrograde flow proportion (P

To investigate characteristics of intra- and extracranial arterial culprit plaques between patients with single infarct and multiple-infarcts by a head-neck combined high resolution magnetic resonance vessel wall imaging (HR-MRVWI). Forty-three patients with recent ischemic stroke due to large artery atherosclerosis were enrolled. The head-neck combined HR-MRVWI was performed in all patients both pre- and post-contrast administration. Based on diffusion weighted imaging findings, patients were divided into single-infarction and multiple-infarction groups. For patients with anterior circulation ischemic stroke, they were also divided into perforating artery infarction (PAI) and non-PAI groups. Patient demographics, number and location of culprit plaques, artery stenosis percentage, intraplaque hemorrhage, and plaque enhancement were evaluated and compared between single-infarction and multiple-infarction groups, as well as between PAI and non-PAI groups. A total of 83 culprit plaques were identified. The artery stenosis degree was more severe and plaque enhancement more prominent in multiple-infarction group than in single-infarction group. Patients with multiple infarcts also had more culprit plaques per patient than those with single infarct, which contributed to the occurrence of multiple infarcts. For comparison of PAI and non-PAI groups, a higher artery stenosis percentage was observed in non-PAI group, and patients with non-PAI had more culprit plaques per patient, which contributed to a variety of infarct manifestations. A higher stenosis grade and higher number of culprit plaques seem to be associated with a higher number of cerebral infarcts in patients with large artery atherosclerosis. [ABSTRACT FROM AUTHOR]