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Neuroimaging
Review
Comprehensive imaging analysis of intracranial atherosclerosis
Free
  1. Sebastian Sanchez1,
  2. Mahmud Mossa-Basha2,
  3. Vania Anagnostakou3,
  4. David S Liebeskind4,
  5. Edgar A Samaniego5
  1. 1 Neurology, Yale University, New Haven, Connecticut, USA
  2. 2 Radiology, University of Washington, Seattle, Washington, USA
  3. 3 Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
  4. 4 Department of Neurology, University of California Los Angeles, Los Angeles, California, USA
  5. 5 Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  1. Correspondence to Dr Edgar A Samaniego; edgarsama{at}gmail.com

Abstract

Intracranial atherosclerotic disease (ICAD) involves the build-up of atherosclerotic plaques in cerebral arteries, significantly contributing to stroke worldwide. Diagnosing ICAD entails various techniques that measure arterial stenosis severity. Digital subtraction angiography, CT angiography, and magnetic resonance angiography are established methods for assessing stenosis. High-resolution MRI offers additional insights into plaque morphology including plaque burden, hemorrhage, remodeling, and contrast enhancement. These metrics and plaque traits help identify symptomatic plaques. Techniques like transcranial Doppler, CT perfusion, computational fluid dynamics, and quantitative MRA analyze blood flow restrictions due to ICAD. Intravascular ultrasound or optical coherence tomography have a very high spatial resolution and can assess the structure of the arterial wall and the plaque from the lumen of the target vascular territory. Positron emission tomography could further detect inflammation markers. This review aims to provide a comprehensive overview of the spectrum of current modalities for atherosclerotic plaque analysis and risk stratification.

  • Atherosclerosis
  • Stroke
  • Vessel Wall
  • Magnetic Resonance Angiography

https://doi.org/10.1136/jnis-2023-020622

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    Footnotes

    • X @esamaniego

    • Contributors SS, MMB, VA, DSL: Data collection and manuscript drafting. EAS: Conception and design, drafting and revising the article.

    • Funding This work was conducted on an MRI instrument founded by (1S10OD0250225-01) at the University of Iowa.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.