TY - JOUR
T1 - Arterial spin labeling MRI in carotid stenosis
T2 - Arterial transit artifacts may predict symptoms
AU - Di Napoli, Alberto
AU - Cheng, Suk Fun
AU - Gregson, John
AU - Atkinson, David
AU - Markus, Julia Emily
AU - Richards, Toby
AU - Brown, Martin M.
AU - Sokolska, Magdalena
AU - Jäger, Hans Rolf
N1 - Funding Information:
Study sponsored by the University College London and University College London Hospitals NHS Foundation Trust, which received a proportion of funding from the UK Department of Health's National Institute for Health Research Biomedical Research Centers funding scheme. The Stroke Association and CORDA funded the costs of the MRIs.
Funding Information:
Disclosures of Conflicts of Interest: A.D.N. disclosed no relevant relationships. S.F.C. disclosed no relevant relationships. J.G. disclosed no relevant relationships. D.A. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: disclosed that Philips Healthcare provided MRI simulator software and clinical science support to author’s institution. Other relationships: disclosed no relevant relationships. J.E.M. disclosed no relevant relationships. T.R. disclosed no relevant relationships. M.M.B. Activities related to the present article: disclosed funding from the Stroke Association for part of the cost of the MRI scans. Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships. M.S. disclosed no relevant relationships. H.R.J. disclosed no relevant relationships.
Funding Information:
Study sponsored by the University College London and University College London Hospitals NHS Foundation Trust, which received a proportion of funding from the UK Department of Health’s National Institute for Health Research Biomedical Research Centers funding scheme. The Stroke Association and CORDA funded the costs of the MRIs.
Publisher Copyright:
© RSNA, 2020.
PY - 2020/12
Y1 - 2020/12
N2 - Background: Stenosis of the internal carotid artery has a higher risk for stroke. Many investigations have focused on structure and plaque composition as signs of plaque vulnerability, but few studies have analyzed hemodynamic changes in the brain as a risk factor. Purpose: To use 3-T MRI methods including contrast material-enhanced MR angiography, carotid plaque imaging, and arterial spin labeling (ASL) to identify imaging parameters that best help distinguish between asymptomatic and symptomatic participants with carotid stenosis. Materials and Methods: Participants with carotid stenosis from two ongoing prospective studies who underwent ASL and carotid plaque imaging with use of 3-T MRI in the same setting from 2014 to 2018 were studied. Participants were assessed clinically for recent symptoms (transient ischemic attack or stroke) and divided equally into symptomatic and nonsymptomatic groups. Reviewers were blinded to the symptomatic status and MRI scans were analyzed for the degree of stenosis, plaque surface structure, presence of intraplaque hemorrhage (IPH), circle of Willis collaterals, and the presence and severity of arterial transit artifacts (ATAs) at ASL imaging. MRI findings were correlated with symptomatic status by using t tests and the Fisher exact test. Results: A total of 44 participants (mean age, 71 years ± 10 [standard deviation]; 31 men) were evaluated. ATAs were seen only in participants with greater than 70% stenosis (16 of 28 patients; P < .001) and were associated with absence of anterior communicating artery (13 of 16 patients; P = .003). There was no association between history of symptoms and degree of stenosis (27 patients with ≥70% stenosis and 17 patients with <70%; P = .54), IPH (12 patients with IPH and 32 patients without IPH; P = .31), and plaque surface structure (17 patients with irregular or ulcerated plaque and 27 with smooth plaque; P = .54). Participants with ATAs (n = 16) were more likely to be symptomatic than were those without ATAs (n = 28) (P = .004). Symptomatic status also was associated with the severity of ATAs (P = .002). Conclusion: Arterial transit artifacts were the only factor associated with recent ischemic symptoms in participants with carotid stenosis. The degree of stenosis, plaque ulceration, and intraplaque hemorrhage were not associated with symptomatic status.
AB - Background: Stenosis of the internal carotid artery has a higher risk for stroke. Many investigations have focused on structure and plaque composition as signs of plaque vulnerability, but few studies have analyzed hemodynamic changes in the brain as a risk factor. Purpose: To use 3-T MRI methods including contrast material-enhanced MR angiography, carotid plaque imaging, and arterial spin labeling (ASL) to identify imaging parameters that best help distinguish between asymptomatic and symptomatic participants with carotid stenosis. Materials and Methods: Participants with carotid stenosis from two ongoing prospective studies who underwent ASL and carotid plaque imaging with use of 3-T MRI in the same setting from 2014 to 2018 were studied. Participants were assessed clinically for recent symptoms (transient ischemic attack or stroke) and divided equally into symptomatic and nonsymptomatic groups. Reviewers were blinded to the symptomatic status and MRI scans were analyzed for the degree of stenosis, plaque surface structure, presence of intraplaque hemorrhage (IPH), circle of Willis collaterals, and the presence and severity of arterial transit artifacts (ATAs) at ASL imaging. MRI findings were correlated with symptomatic status by using t tests and the Fisher exact test. Results: A total of 44 participants (mean age, 71 years ± 10 [standard deviation]; 31 men) were evaluated. ATAs were seen only in participants with greater than 70% stenosis (16 of 28 patients; P < .001) and were associated with absence of anterior communicating artery (13 of 16 patients; P = .003). There was no association between history of symptoms and degree of stenosis (27 patients with ≥70% stenosis and 17 patients with <70%; P = .54), IPH (12 patients with IPH and 32 patients without IPH; P = .31), and plaque surface structure (17 patients with irregular or ulcerated plaque and 27 with smooth plaque; P = .54). Participants with ATAs (n = 16) were more likely to be symptomatic than were those without ATAs (n = 28) (P = .004). Symptomatic status also was associated with the severity of ATAs (P = .002). Conclusion: Arterial transit artifacts were the only factor associated with recent ischemic symptoms in participants with carotid stenosis. The degree of stenosis, plaque ulceration, and intraplaque hemorrhage were not associated with symptomatic status.
UR - http://www.scopus.com/inward/record.url?scp=85096347617&partnerID=8YFLogxK
U2 - 10.1148/radiol.2020200225
DO - 10.1148/radiol.2020200225
M3 - Article
C2 - 33048034
AN - SCOPUS:85096347617
SN - 0033-8419
VL - 297
SP - 652
EP - 660
JO - Radiology
JF - Radiology
IS - 3
ER -