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PT  - JOURNAL ARTICLE
AU  - Patel, Abhinav
AU  - Abdalla, Ramez N.
AU  - Allaw, Sammy
AU  - Cantrell, Donald R.
AU  - Shaibani, Ali
AU  - Caprio, Frances
AU  - Hasan, David M.
AU  - Alaraj, Ali
AU  - Polster, Sean P.
AU  - Carroll, Timothy J.
AU  - Ansari, Sameer A.
TI  - Temporal Changes on Postgadolinium MR Vessel Wall Imaging Captures Enhancement Kinetics of Intracranial Atherosclerotic Plaques and Aneurysms
AID  - 10.3174/ajnr.A8370
DP  - 2024 Sep 01
TA  - American Journal of Neuroradiology
PG  - 1206--1213
VI  - 45
IP  - 9
4099  - http://www.ajnr.org/content/45/9/1206.short
4100  - http://www.ajnr.org/content/45/9/1206.full
SO  - Am. J. Neuroradiol.2024 Sep 01; 45
AB  - BACKGROUND AND PURPOSE: Analysis of vessel wall contrast kinetics (ie, wash-in/washout) is a promising method for the diagnosis and risk-stratification of intracranial atherosclerotic disease plaque (ICAD-P) and the intracranial aneurysm walls (IA-W). We used black-blood MR imaging or MR vessel wall imaging to evaluate the temporal relationship of gadolinium contrast uptake kinetics in ICAD-Ps and IA-Ws compared with normal anatomic reference structures.MATERIALS AND METHODS: Patients with ICAD-Ps or IAs who underwent MR vessel wall imaging with precontrast, early postcontrast (5–15 minutes), and delayed postcontrast (20–30 minutes) 3D T1-weighted TSE sequences were retrospectively studied. ROIs of a standardized diameter (2 mm) were used to measure the signal intensities of the cavernous sinus, pituitary infundibulum, temporalis muscle, and choroid plexus. Point ROIs were used for ICAD-Ps and IA-Ws. All ROI signal intensities were normalized to white matter signal intensity obtained using ROIs of 10-mm diameter. Measurements were acquired on precontrast, early postcontrast, and delayed postcontrast 3D T1 TSE sequences for each patient.View this table:Table 1: MR-VWI parameters for ICAD-Ps and IAsRESULTS: Ten patients with 17 symptomatic ICAD-Ps and 30 patients with 34 IA-Ws were included and demonstrated persisting contrast uptake (P &amp;lt; .001) of 7.21% and 10.54% beyond the early phase (5–15 minutes postcontrast) and in the delayed phase (20–30 minutes postcontrast) on postcontrast MR vessel wall imaging. However, normal anatomic reference structures including the pituitary infundibulum and cavernous sinus demonstrated a paradoxical contrast washout in the delayed phase. In both ICAD-Ps and IA-Ws, the greatest percentage of quantitative enhancement (&amp;gt;70%–90%) occurred in the early phase of postcontrast imaging, consistent with the rapid contrast uptake kinetics of neurovascular pathology.CONCLUSIONS: Using standard MR vessel wall imaging techniques, our results demonstrate the effects of gadolinium contrast uptake kinetics in ICAD-Ps and IA-Ws with extended accumulating enhancement into the delayed phase (&amp;gt; 15 minutes) as opposed to normal anatomic reference structures that conversely exhibit decreasing enhancement. Because these relative differences are used to assess qualitative patterns of ICAD-P and IA-W enhancement, our findings highlight the importance of standardizing acquisition time points and MR vessel wall imaging protocols to interpret pathologic enhancement for the risk stratification of cerebrovascular pathologies.AWEaneurysm wall enhancementIAintracranial aneurysmIA-Wintracranial aneurysm wallICADintracranial atherosclerotic diseaseICAD-Pintracranial atherosclerotic disease plaqueKtransvolume transfer constantSIsignal intensityVWIvessel wall imaging