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Background: Small vessel disease (SVD) shares common vascular risk factors with large artery disease (LAD). However, little is known about the relationship between intracranial artery stenosis and SVD burden. Purpose: To investigate whether SVD burden correlates with severity of intracranial LAD. Study Type: Retrospective. Population: Five hundred and sixteen patients with LAD of arterial circulation were enrolled from one hospital, including 384 males (59 ± 11 years) and 132 females (60 ± 12 years). Field Strength/Sequence: 3 T. T1‐weighted fast spin echo (T1W FSE), T2W FSE, T2 fluid attenuated inversion recovery, diffusion‐weighted imaging, susceptibility‐weight imaging, and time‐of‐flight magnetic resonance angiography. Assessment: The LAD was divided into mild stenosis (<30%), moderate stenosis (30%–69%), and severe stenosis (≥70%). The Standard for Reporting Vascular Changes on Neuroimaging criteria was used to rate the SVD burden according to the level of white matter hyperintensity (WMH), perivascular space (PVS), cerebral microbleed (CMB), and lacunes. Statistical Tests: Lilliefors test, ANOVA, chi‐squared test, Mann–Whitney U test, Wilcoxon signed rank test, Bonferroni test, Spearman's correlation, logistic regression, and Cohen's kappa test. Results: The grade scores for centrum semiovale PVS (CS‐PVS) were positively correlated with the degree of stenosis (R = 0.413), whereas the presence of severe basal ganglia PVS (BG‐PVS) was associated with CMB (R = 0.508), lacunes (R = 0.365), and severe WMH (R = 0.478). In multivariate analysis, severe CS‐PVS (adjusted odds ratio [aOR], 3.1; 95% confidence interval [CI], 1.9–4.8) and lacunes (aOR, 2.1; 95% CI, 1.3–3.4) were associated with severe stenosis of LAD. In addition, CS‐PVS was related to severe stenosis in a dose‐dependent manner: when CS‐PVS score was 3 and 4, the aORs of severe stenosis were 1.9 and 7.7, respectively. Data Conclusion: The severity of LAD in anterior circulation is associated with SVD burden, which suggests that different SVD burden may be used for risk stratification in LAD. Evidence Level: 3 Technical Efficacy: Stage 3 [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of 3D pseudocontinuous arterial spin labeling (3D pCASL) in the differential diagnosis between mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS) and acute ischemic stroke (AIS).Materials and Methods: Conventional magnetic resonance imaging (MRI) including T2 -weighted imaging (T2 WI) and diffusion-weighted imaging (DWI), and 3D pCASL perfusion data were obtained on a 3.0T MR scanner in 16 newly appearing lesions in nine patients with MELAS and 14 acute lesions in 12 patients with AIS. A postlabeling delay (PLD) time of 2025 msec was applied. The cerebral blood flow (CBF) values were measured in the central part and the peripheral part of the lesions and the CBF values were compared between MELAS and AIS patients.Results: The lesions of both MELAS and AIS showed high signal intensity on T2 WI and demonstrated hyperintensity on DWI. Compared with the perfusion defects or hypoperfusion in all AIS, hyperperfusion was revealed in 16 acute MELAS lesions, especially in the peripheral part of the lesions. The CBF values of 16 lesions in MELAS were 11.20-73.11 ml/100g/min in the central part and 65.33-169.11 ml/100g/min in the peripheral part. The CBF values of 14 lesions in AIS were 12.32-19.94 ml/100g/min in the central part and 11.66-18.37 ml/100g/min in the peripheral part. The CBF value of the peripheral part (119.80 ± 35.41) in MELAS was significantly higher than that (14.66 ± 2.61) in AIS (P = 0.0001).Conclusion: The whole-brain 3D pCASL technique might be useful in differentiating MELAS from AIS.Level Of Evidence: 3 J. Magn. Reson. Imaging 2017;45:199-206. [ABSTRACT FROM AUTHOR]