Neurosurg Rev. 2025 Dec 5;49(1):50. doi: 10.1007/s10143-025-03978-0.
ABSTRACT
Intracranial atherosclerosis (ICAS) is a leading cause of ischemic stroke (IS). Conventional imaging poorly reflects plaque activity, whereas arterial wall enhancement on high-resolution MR vessel-wall imaging (HRMR-VWI) may serve as a marker of vascular disease activity. This study investigated the clinical, laboratory, and imaging factors associated with intracranial arterial wall enhancement and its value as an imaging biomarker of atherosclerotic burden. This single-center retrospective study included 470 ICAS-IS patients who underwent HRMR-VWI between March 2017 and July 2020. Enhancement grades (0-2) of culprit arteries were assessed. Clinical, biochemical, and imaging variables were compared across grades, and multinomial logistic regression identified independent predictors of enhancement severity. Among 470 patients (mean age 62.7 ± 10.6 years; 73.2% male), 78.5% showed intracranial arterial enhancement (grade ≥1), and 48.7% had grade 2 enhancement. Independent predictors of higher enhancement grades included the total number of stenotic vessels (grade 1 vs. 0: OR = 2.33; grade 2 vs. 0: OR = 2.09), number of enhanced vessels (grade 1 vs. 0: OR = 0.60; grade 2 vs. 0: OR = 0.63), presence of culprit-artery stenosis (grade 1 vs. 0: OR = 0.07; grade 2 vs. 0: OR= 0.03), and large-artery atherosclerosis (LAA) subtype (grade 1 vs. 0: OR = 4.44; grade 2 vs. 0: OR = 9.40; all P < 0.001). Non-stenotic enhancement occurred in 11.9% of patients. Intracranial arterial wall enhancement on HRMR-VWI is closely related to stenotic burden and shows a strong association with the LAA subtype. Enhancement grading may serve as a noninvasive imaging biomarker for evaluating disease activity and improving stroke subtype classification.
PMID:41348180 | DOI:10.1007/s10143-025-03978-0