Vessel wall MR imaging of aortic arch, cervical carotid and intracranial arteries in patients with embolic stroke of undetermined source: A narrative review

Despite advancements in multi-modal imaging techniques, a substantial portion of ischemic stroke patients today remain without a diagnosed etiology after conventional workup. Based on existing diagnostic criteria, these ischemic stroke patients are subcategorized into having cryptogenic stroke (CS)...

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Main Authors: Yu Sakai, Vance T. Lehman, Laura B. Eisenmenger, Emmanuel C. Obusez, G. Abbas Kharal, Jiayu Xiao, Grace J. Wang, Zhaoyang Fan, Brett L. Cucchiara, Jae W. Song
Format: Article
Language:English
Published: Frontiers Media S.A. 2022-07-01
Series:Frontiers in Neurology
Subjects:
Online Access:https://www.frontiersin.org/articles/10.3389/fneur.2022.968390/full
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author Yu Sakai
Vance T. Lehman
Laura B. Eisenmenger
Emmanuel C. Obusez
G. Abbas Kharal
Jiayu Xiao
Grace J. Wang
Zhaoyang Fan
Brett L. Cucchiara
Jae W. Song
author_facet Yu Sakai
Vance T. Lehman
Laura B. Eisenmenger
Emmanuel C. Obusez
G. Abbas Kharal
Jiayu Xiao
Grace J. Wang
Zhaoyang Fan
Brett L. Cucchiara
Jae W. Song
author_sort Yu Sakai
collection DOAJ
description Despite advancements in multi-modal imaging techniques, a substantial portion of ischemic stroke patients today remain without a diagnosed etiology after conventional workup. Based on existing diagnostic criteria, these ischemic stroke patients are subcategorized into having cryptogenic stroke (CS) or embolic stroke of undetermined source (ESUS). There is growing evidence that in these patients, non-cardiogenic embolic sources, in particular non-stenosing atherosclerotic plaque, may have significant contributory roles in their ischemic strokes. Recent advancements in vessel wall MRI (VW-MRI) have enabled imaging of vessel walls beyond the degree of luminal stenosis, and allows further characterization of atherosclerotic plaque components. Using this imaging technique, we are able to identify potential imaging biomarkers of vulnerable atherosclerotic plaques such as intraplaque hemorrhage, lipid rich necrotic core, and thin or ruptured fibrous caps. This review focuses on the existing evidence on the advantages of utilizing VW-MRI in ischemic stroke patients to identify culprit plaques in key anatomical areas, namely the cervical carotid arteries, intracranial arteries, and the aortic arch. For each anatomical area, the literature on potential imaging biomarkers of vulnerable plaques on VW-MRI as well as the VW-MRI literature in ESUS and CS patients are reviewed. Future directions on further elucidating ESUS and CS by the use of VW-MRI as well as exciting emerging techniques are reviewed.
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spelling doaj.art-31500f5272cd47b4b134253e0a9854b72022-12-22T02:14:30ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-07-011310.3389/fneur.2022.968390968390Vessel wall MR imaging of aortic arch, cervical carotid and intracranial arteries in patients with embolic stroke of undetermined source: A narrative reviewYu Sakai0Vance T. Lehman1Laura B. Eisenmenger2Emmanuel C. Obusez3G. Abbas Kharal4Jiayu Xiao5Grace J. Wang6Zhaoyang Fan7Brett L. Cucchiara8Jae W. Song9Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United StatesDepartment of Radiology, The Mayo Clinic, Rochester, MN, United StatesDepartment of Radiology, University of Wisconsin-Madison, Madison, WI, United StatesDepartment of Radiology, Cleveland Clinic, Cleveland, OH, United StatesDepartment of Neurology, Cerebrovascular Center, Neurological Institute, Cleveland, OH, United StatesDepartment of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United StatesDepartment of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, PA, United StatesDepartment of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United StatesDepartment of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, United StatesDepartment of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United StatesDespite advancements in multi-modal imaging techniques, a substantial portion of ischemic stroke patients today remain without a diagnosed etiology after conventional workup. Based on existing diagnostic criteria, these ischemic stroke patients are subcategorized into having cryptogenic stroke (CS) or embolic stroke of undetermined source (ESUS). There is growing evidence that in these patients, non-cardiogenic embolic sources, in particular non-stenosing atherosclerotic plaque, may have significant contributory roles in their ischemic strokes. Recent advancements in vessel wall MRI (VW-MRI) have enabled imaging of vessel walls beyond the degree of luminal stenosis, and allows further characterization of atherosclerotic plaque components. Using this imaging technique, we are able to identify potential imaging biomarkers of vulnerable atherosclerotic plaques such as intraplaque hemorrhage, lipid rich necrotic core, and thin or ruptured fibrous caps. This review focuses on the existing evidence on the advantages of utilizing VW-MRI in ischemic stroke patients to identify culprit plaques in key anatomical areas, namely the cervical carotid arteries, intracranial arteries, and the aortic arch. For each anatomical area, the literature on potential imaging biomarkers of vulnerable plaques on VW-MRI as well as the VW-MRI literature in ESUS and CS patients are reviewed. Future directions on further elucidating ESUS and CS by the use of VW-MRI as well as exciting emerging techniques are reviewed.https://www.frontiersin.org/articles/10.3389/fneur.2022.968390/fullvessel wall MRIatherosclerosisimagingcerebrovascular disease/strokeembolic stroke of undetermined source (ESUS)stroke
spellingShingle Yu Sakai
Vance T. Lehman
Laura B. Eisenmenger
Emmanuel C. Obusez
G. Abbas Kharal
Jiayu Xiao
Grace J. Wang
Zhaoyang Fan
Brett L. Cucchiara
Jae W. Song
Vessel wall MR imaging of aortic arch, cervical carotid and intracranial arteries in patients with embolic stroke of undetermined source: A narrative review
Frontiers in Neurology
vessel wall MRI
atherosclerosis
imaging
cerebrovascular disease/stroke
embolic stroke of undetermined source (ESUS)
stroke
title Vessel wall MR imaging of aortic arch, cervical carotid and intracranial arteries in patients with embolic stroke of undetermined source: A narrative review
title_full Vessel wall MR imaging of aortic arch, cervical carotid and intracranial arteries in patients with embolic stroke of undetermined source: A narrative review
title_fullStr Vessel wall MR imaging of aortic arch, cervical carotid and intracranial arteries in patients with embolic stroke of undetermined source: A narrative review
title_full_unstemmed Vessel wall MR imaging of aortic arch, cervical carotid and intracranial arteries in patients with embolic stroke of undetermined source: A narrative review
title_short Vessel wall MR imaging of aortic arch, cervical carotid and intracranial arteries in patients with embolic stroke of undetermined source: A narrative review
title_sort vessel wall mr imaging of aortic arch cervical carotid and intracranial arteries in patients with embolic stroke of undetermined source a narrative review
topic vessel wall MRI
atherosclerosis
imaging
cerebrovascular disease/stroke
embolic stroke of undetermined source (ESUS)
stroke
url https://www.frontiersin.org/articles/10.3389/fneur.2022.968390/full
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