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22. European Stroke Conference 392 © 2013 S. Karger AG, Basel Scientific Programme Figure 3. LM and TEM images of an unruptured aneurysm. (A) An unruptured aneurysm wall revealing a hypocellular vascular wall with abundance of VV complexes (arrow heads). Scale bar= 20 μm (B) Large VV filled with RBCs show no sign of inflammatory cells unlike the ruptured IA. Scale bar= 5 μm (C) Foam cells and macrophages within the hypocellular wall. Disarray and abundance of collagen. Scale bar= 5 μm (D) Closer look at abundance of FC and macrophages. Scale bar= 5 μm 206 Vascular imaging Evaluating middle cerebral artery atherosclerotic lesions in acute ischemic stroke using mag-netic resonance T1-weighted three-dimensional vessel wall imaging (3D-VWI) T. Natori1, M. Sasaki2, M. Miyoshi3, H. Ohba4, N. Katsura5, M. Yamaguchi6, S. Narumi7, H. Kaba-sawa8, K. Kudo9, K. Ito10, Y. Terayama11 Department of Neurology and Gerontology, Iwate Medical University, Morioka, JAPAN1, Di-vision of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Mo-rioka, JAPAN2, GE healthcare Japan, Tokyo, JAPAN3, Department of Neurology and Gerontology, Iwate Medical University, Morioka, JAPAN4, Department of Neurology and Gerontology, Iwate Medical University, Morioka, JAPAN5, Department of Neurology and Gerontology, Iwate Medical University, Morioka, JAPAN6, Department of Neurology and Gerontology, Iwate Medical Universi-ty, Morioka, JAPAN7, GE healthcare Japan, Tokyo, JAPAN8, Division of Ultrahigh Field MRI, Insti-tute for Biomedical Sciences, Iwate Medical University, Morioka, JAPAN9, Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Mo-rioka, JAPAN10, Department of Neurology and Gerontology, Iwate Medical University, Morioka, JAPAN11 Background: Atherosclerotic lesions in major intracranial arteries are a leading cause of ischemic stroke. Magnetic resonance angiography (MRA) is often used to assess atherosclerotic changes by detecting luminal narrowing, while it cannot directly visualize atherosclerotic lesions. The present study is to evaluate intracranial arterial wall changes in acute ischemic stroke using a novel three-di-mensional vessel wall imaging (3D-VWI) technique. Methods: We prospectively examined 21 consecutive patients with acute non-cardioembolic stroke in middle cerebral artery (MCA) territory by using a 1.5-T MR scanner. All patients were exam-ined by T1-weighted (T1W) 3D-VWI and axial 3D time-of-flight (TOF) MRA. T1W 3D-VWI was obtained using a flow-sensitized 3D fast spin-echo technique. Wall thickening of MCA, which is suggestive of atherosclerotic plaques, was visually evaluated and the contrast ratio (CR) of signal intensity of the lesions against that of the corpus callosum was calculated. These changes were then compared with the stenotic changes observed on MRA. Results: On 3D-VWI, the wall thickening of the ipsilateral and contralateral MCA were observed in almost all patients (95.2% and 95.2%, respectively), while evident stenotic changes were found on MRA only in one patient (5.9%) (p <0.001). The median CRs of the thickened walls in the ipsi-lateral and contralateral M1 segments on 3D-VWI were 50.0% (interquartile range, 46.1 to 56.7%) and 44.9% (41.5 to 47.2%), respectively. The CR of the thickened wall in the ipsilateral MCA was significantly higher than that in the contralateral MCA (p=0.028), indicating that those were unstable plaques consisting of hemorrhage or lipid. Conclusions: The T1W 3D-VWI can provide direct visualization of atherosclerotic lesions of the intracranial arteries in stroke patients even in those without substantial stenosis on MRA, and it can detect signal change suggestive of unstable plaque.


Karger_ESC London_2013
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