Role of Vessel Wall MRI in Differentiaition Between Intracranial Atherosclerotic Disease and Vasculitis as Causes of Ischemic Stroke

Official title

Role of Vessel Wall MRI in Differentiaition Between Intrcranial Atherosclerotic Disease and Vasculitis as Causes of Ischemic Stroke

Overview

This work aims to clarify the diagnostic ability of vessel wall MRI to differentiate between intracranial atherosclerotic disease and vasculitis as causes of ischemic stroke, thereby guiding appropriate treatment and improving patient outcomes.

Detailed description

Intracranial arterial diseases, such as intracranial atherosclerotic disease (ICAD) and vasculitis, are major contributors to ischemic stroke globally. Differentiating these conditions, which is critical for effective clinical management given their distinct pathogenic mechanisms and therapeutic requirements. Traditional imaging modalities, including magnetic resonance angiography (MRA), computed tomography angiography (CTA), and digital subtraction angiography (DSA), predominantly assess the arterial lumen, detecting stenosis or occlusion. While valuable for identifying luminal abnormalities, these techniques often fail to characterize the vessel wall pathology, a key limitation in distinguishing between ICAD and vasculitis. Both conditions can manifest with similar clinical presentations of ischemic stroke, rendering diagnosis challenging with conventional methods.

Vessel wall magnetic MRI has emerged as an effective diagnostic tool. This non-invasive technique directly visualizes and characterizes the intracranial arterial wall, providing detailed information on wall thickening patterns, contrast enhancement characteristics, and plaque morphology. Current strategies show ability of vessel wall MRI to differentiate Intracranial atherosclerotic disease, typically presenting with eccentric wall thickening and eccentric enhancement if the atherosclerotic plaque is active and no enhancement if the atherosclerotic plaque is inactive, from vasculitis, which often exhibits circumferential wall thickening and enhancement.

The rationale for utilizing vessel wall magnetic resonance imaging stems from the need to move beyond mere luminal assessment to a more granular, tissue-level understanding of cerebrovascular disease. This advanced characterization facilitates precise diagnosis, guides appropriate treatment decisions-such as antiplatelet therapy for intracranial atherosclerotic disease versus immunosuppression for vasculitis-and ultimately aims to improve patient outcomes following ischemic stroke.

Interventions

• Device MRI
  Vessel wall MRI in differentiation between intracranial atherosclerotic disease and vasculitis as causes of ischemic stroke

Primary outcome measures

• Role of vessel wall MRI in differentiation between intracranial atherosclerotic disease and vasculitis as causes of ischemic stroke by detection of eccentric or circumferential arterial wall thickening and pattern of postcontrast enhancement. [Time frame: Baseline]

Eligibility criteria

Inclusion criteria

• Patients with ischemic stroke within 2 weeks from onset detected by magnetic resonance imaging (MRI) and have intracranial artery stenosis seen in magnetic resonance angiography (MRA).

Exclusion criteria

• Contraindications for MRI such as claustrophobia, heart pacemaker and ferromagnetic implants.

• Contraindications for contrast as patients with renal impairment.
• Patients in which the misaligned images or distortions due to motion artifacts made the interpretation of the MRI unreliable.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Diagnostic

Study locations

Center list to be confirmed — check the primary protocol.

Publications

• Li F, Wang Y, Hu T, Wu Y. Application and interpretation of vessel wall magnetic resonance imaging for intracranial atherosclerosis: a narrative review. Ann Transl Med. 2022 Jun;10(12):714. doi: 10.21037/atm-22-2364. PMID 35845481
• D'Aniello S, Rustici A, Gramegna LL, Godi C, Piccolo L, Gentile M, Zini A, Carrozzi A, Lodi R, Tonon C, Dall'Olio M, Simonetti L, Chieffo R, Anzalone N, Cirillo L. The Contribution of Vessel Wall Magnetic Resonance Imaging to the Diagnosis of Primary and Secondary Central Nervous System Vasculitis. Diagnostics (Basel). 2024 Apr 29;14(9):927. doi: 10.3390/diagnostics14090927. PMID 38732340
• Hu T, Ling R, Zhu Y. Advancements in imaging of intracranial atherosclerotic disease: beyond the arterial lumen to the vessel wall. Rev Neurosci. 2024 Nov 19;36(3):229-241. doi: 10.1515/revneuro-2024-0076. Print 2025 Apr 28. PMID 39565965
• Chaganti J, Woodford H, Tomlinson S, Dunkerton S, Brew B. Black blood imaging of intracranial vessel walls. Pract Neurol. 2020 Dec 29:practneurol-2020-002806. doi: 10.1136/practneurol-2020-002806. Online ahead of print. PMID 33376151
• Mazzacane F, Mazzoleni V, Scola E, Mancini S, Lombardo I, Busto G, Rognone E, Pichiecchio A, Padovani A, Morotti A, Fainardi E. Vessel Wall Magnetic Resonance Imaging in Cerebrovascular Diseases. Diagnostics (Basel). 2022 Jan 20;12(2):258. doi: 10.3390/diagnostics12020258. PMID 35204348
• Alzein MM, Patel A, Abdalla RN, Cantrell DR, Shaibani A, Ansari SA. MR Vessel Wall Imaging for Atherosclerosis and Vasculitis. Neuroimaging Clin N Am. 2024 May;34(2):251-260. doi: 10.1016/j.nic.2024.02.001. PMID 38604709
• Edjlali M, Qiao Y, Boulouis G, Menjot N, Saba L, Wasserman BA, Romero JM. Vessel wall MR imaging for the detection of intracranial inflammatory vasculopathies. Cardiovasc Diagn Ther. 2020 Aug;10(4):1108-1119. doi: 10.21037/cdt-20-324. PMID 32968663
• Tritanon O, Mataeng S, Apirakkan M, Panyaping T. Utility of high-resolution magnetic resonance vessel wall imaging in differentiating between atherosclerotic plaques, vasculitis, and arterial dissection. Neuroradiology. 2023 Mar;65(3):441-451. doi: 10.1007/s00234-022-03093-7. Epub 2022 Dec 2. PMID 36456894

Identifiers

NCT: NCT07448454 · Vessel wall MRI

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗