Stroke is one of the major causes of morbidity and mortality worldwide and is the number one cause of adult disability. This disease primarily arises from pathogenesis in a large blood vessel such as the aorta, carotid artery, and intracranial artery and venous sinus. Black-blood MR, commonly known as MR vessel wall imaging (VWI), has emerged as a leading noninvasive imaging modality for directly assessing the vessel wall. Many of previous studies have shown the promise of using MR VWI for characterizing different vessel wall pathologies that potentially result in a stroke. The present lecture will focus on recent (within the last decade) technical developments in MR VWI at the carotid artery, intracranial vessels, and aortic arteries.
Highlights
· Stroke and its relation to large blood vessels
· MR techniques for carotid vessel wall imaging
· MR techniques for intracranial vessel wall imaging techniques
· MR techniques for aortic vessel wall imaging techniques
Target Audience
Radiologists, technologists and basic scientists with an interest in stroke-related vessel wall imagingUpon the completion of this lecture, participants should be able to
1. understand the relation between stroke incidence and large vessel diseases
2. review vessel wall imaging techniques for different vascular parts that may be involved in stroke
3. understand the technical strengths and weaknesses of each technique.
Outline
Stroke is one of the major causes of morbidity and mortality worldwide and is the number one cause of adult disability.1 This disease primarily arises from pathogenesis in a large blood vessel such as the aorta, carotid artery, and intracranial artery and venous sinus. Traditional vascular examinations rely on luminography imaging, including computed tomography (CT) angiography, ultrasonography, magnetic resonance (MR) angiography, and digital subtraction angiography (DSA). These imaging techniques are limited to the detection of luminal abnormalities and thus inadequate for characterizing underlying vessel wall pathologies or confirming the etiology.2
Black-blood MR, commonly known as MR vessel wall imaging (VWI), has emerged as a leading noninvasive imaging modality for directly assessing the vessel wall. Many of previous studies have shown the promise of using MR VWI for characterizing different vessel wall pathologies that potentially result in a stroke. Research for understanding pathophysiology and developing novel preventative and treatment strategies have now been possible because of the success in technical development of MR VWI. The present lecture will focus on recent (within the last decade) technical developments in MR VWI at the carotid artery, intracranial vessels, and aortic arteries.
MR VWI at the carotid artery has gained tremendous research interests in the past over two decades. The trend of technical development is currently moving towards higher imaging efficiency, easier workflow, robustness to motion, and more quantitative evaluations. A series of recently developed techniques, aimed for, for example, dual-3 or multi-contrast VWI4, swallowing motion compensation5,6, dynamic contrast enhanced imaging7,8, and T1/T2 mapping9, will be discussed in the lecture. A recently reached consensus on carotid MR VWI protocols will also be introduced.10
Intracranial VWI, particularly 3D VWI, is becoming a hot research topic in the past few years.11 Compared to the carotid artery, the intracranial vessels present a few more technical challenges such as their small size, deep location, and surrounding cerebrospinal fluid. Several research groups have proposed strategies to overcome the above challenges.12-20 In the lecture, these techniques and associated protocols will be discussed followed by an introduction of a recently reached consensus on intracranial MR VWI protocols.21 Additionally, a unique application of VWI, black-blood thrombus imaging, has been proposed for venous sinus thrombosis evaluations and will be discussed.22
The aorta, particularly the ascending aorta and aortic arch, has been assessed using MR VWI decades ago, but has seen slower technique advancement. One of possible reason is that this location is associated with cardiac and respiratory motion. Compensating for these motion sources can dramatically sacrifice the scan efficiency, resulting prolonged examination or inadequate spatial coverage. A few techniques have been proposed and validated on a relatively smaller cohort of patients.23-27 The lecture will discuss these techniques and some new developments.
MR VWI has demonstrated the potential of unraveling vessel pathologies that contributing to the incidence of a stroke. Continued technical developments are making the modality more accurate, reliable, and easier to use. Further clinical adoption of the tool in stroke-related clinical management awaits randomized clinical trials for many applications, such as diagnosis of culprit lesion, prediction of recurrence, and treatment monitoring.
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