Incremental value of plaque enhancement in predicting stroke recurrence in symptomatic intracranial atherosclerosis

• Published in: Neuroradiology Vol. 62; no. 9; pp. 1123 - 1131
• Main Authors: Song, Xiaowei, Zhao, Xihai, Liebeskind, David S., Wang, Lixue, Xu, Wendeng, Xu, Yilan, Hou, Duoduo, Zheng, Zhuozhao, Wu, Jian
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2020; Springer Nature B.V
• Subjects: Arteriosclerosis; Atherosclerosis; Biomarkers - analysis; Cerebral infarction; Confidence intervals; Contrast Media; Diagnostic Neuroradiology; Female; Gadolinium DTPA; Health risks; Hemodynamics; Humans; Image contrast; Image enhancement; Imaging; Infarction; Intracranial Arteriosclerosis - complications; Intracranial Arteriosclerosis - diagnostic imaging; Ischemia; Male; Markers; Medicine; Medicine & Public Health; Middle Aged; Middle Cerebral Artery - diagnostic imaging; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Plaque, Atherosclerotic - complications; Plaque, Atherosclerotic - diagnostic imaging; Predictive Value of Tests; Prospective Studies; Radiology; Recurrence; Regression analysis; Regression models; Risk analysis; Risk Assessment; Risk factors; Statistical analysis; Stroke; Stroke - etiology; Vessel wall imaging; Stroke recurrence; Imaging markers; Atherosclerosis
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s00234-020-02418-8

Purpose To investigate the association between plaque enhancement and stroke recurrence in subjects with intracranial atherosclerosis. Methods Ischemic stroke patients with symptomatic intracranial atherosclerosis were prospectively included and followed in a comprehensive stroke center. Pre- and post-contrast vessel wall images were used to evaluate plaque enhancement. Other established suggestive imaging markers were also acquired simultaneously. Univariate- and multivariate-adjusted Cox proportional hazard regression models were used to determine the association between plaque enhancement and stroke recurrence. Finally, receiver operating characteristic (ROC) curves were used to demonstrate the predictive value of different imaging markers. Results Of the 60 subjects included, 12 (20.0%) patients presented with ipsilateral stroke recurrence during the median 12-month follow-up. Cox proportional hazard regression models indicated that plaque enhancement was an independent risk factor associated with stroke recurrence after adjusted covariates, with a hazard ratio (HR) of 14.24 and 95% confidence interval (95% CI) (1.21, 168.11), p  = 0.04. In addition, border zone infarction was also statistically significant in predicting stroke recurrence in multi-variable regression (HR = 3.80; 95% CI = 1.04, 13.80; p  = 0.04). Collateral status was in marginal significance (HR = 0.25; 95% CI = 0.06, 1.08; p  = 0.06). ROC analysis indicated that the area under the curve and 95% CI to identify stroke recurrence are 0.67 (0.51, 0.82) for plaque enhancement and 0.71 (0.54, 0.88) for infarction pattern and collateral status and may increase to 0.82 (0.70, 0.93) by combining the three markers above. Conclusion Plaque enhancement is independently associated with stroke recurrence in subjects with intracranial atherosclerosis and has added value to hemodynamic indicators in predicting stroke recurrence.