Exploration of the etiology of single small subcortical infarctions using high-resolution vessel wall MRI

Yutian Li; Quanzhi Feng; Congcong Wang; Xianchang Zhang; Liang Wan; Tong Han

doi:10.3389/fneur.2023.1179730

Exploration of the etiology of single small subcortical infarctions using high-resolution vessel wall MRI

Front Neurol. 2023 May 30:14:1179730. doi: 10.3389/fneur.2023.1179730. eCollection 2023.

Authors

Yutian Li^#^{1

2}, Quanzhi Feng^#¹, Congcong Wang³, Xianchang Zhang⁴, Liang Wan⁵, Tong Han^{1

6}

Affiliations

¹ Department of Radiology, Tianjin Huanhu Hospital, Tianjin University, Tianjin, China.
² Department of Radiology, Qingdao Women and Children's Hospital, Qingdao, Shandong, China.
³ Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
⁴ MR Collaboration, Siemens Healthineers Ltd., Beijing, China.
⁵ Medical College, Tianjin University, Tianjin, China.
⁶ Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin, China.

^# Contributed equally.

Abstract

Objective: We aimed to explore imaging indicators for diagnosing the etiology of single small subcortical infarctions (SSI) using high-resolution vessel wall imaging (HR-VWI).

Methods: Patients with acute isolated subcortical cerebral infarction were prospectively enrolled and classified as having large artery atherosclerosis (LAA), stroke of undetermined etiology (SUD), or small artery disease (SAD). The infarct information, the cerebral small vessel disease (CSVD) score, morphological characteristics of the lenticulostriate arteries (LSAs), and plaque characteristics were compared between the three groups.

Results: Seventy seven patients were enrolled (30 LAA, 28 SUD, and 19 SAD). The total CSVD score of the LAA (P = 0.001) and SUD groups (P = 0.017) was significantly lower than that of the SAD group. The number and total length of LSA branches in the LAA and SUD groups were shorter than in the SAD group. Moreover, the total length laterality index (LI) of the LSAs in the LAA and SUD groups was greater than in the SAD group. The total CSVD score and LI of total length were independent predictors for the SUD and LAA groups. The remodeling index of the SUD group was significantly higher than that of the LAA group (P = 0.002); positive remodeling was dominant in the SUD group (60.7%), whereas remodeling in the LAA group was primarily non-positive (83.3%).

Conclusions: SSI with and without plaques on the carrier artery may have different modes of pathogenesis. Patients with plaques may also have a coexisting mechanism of atherosclerosis.

Keywords: atherosclerotic plaque; high-resolution vessel wall imaging; lenticular artery; small subcortical infarction; stroke classification.

Grants and funding

This work was supported by the National Science Foundation of China (82071994), the National Science Foundation of Tianjin (20JCYBJC00960), and the Shandong Provincial Natural Science Foundation (ZR2022QH127).