Quantitative Pipelines for Tracking and Understanding the Evolution of Cerebrovascular Atherosclerosis with Multi-contrast, Multi-time Point Vessel Wall Magnetic Resonance Imaging

Abstract

Given the substantial global health burden and anticipated rise in mortality rates associated with stroke, imaging of cerebrovascular atherosclerotic plaque plays a crucial role in stroke prevention efforts. Three-dimensional (3D), multi-contrast MR vessel wall imaging (VWI), applied to both carotid and intracranial arteries, offer non-invasive and comprehensive techniques to directly visualize atheromatous plaques and discern their composition, including features such as Gadolinium contrast enhancement (CE) and intraplaque hemorrhage (IPH). Particularly in longitudinal studies, this capability allows for the monitoring of lesion evolution over time, providing valuable insights into the disease process and the efficacy of medical interventions. This research presented advances in VWI analysis of both carotid and cerebral atherosclerosis and deepens our understanding of the evolution of atherosclerosis in the context of stroke.Firstly, regarding intracranial atherosclerosis, standardized pipelines for 3D multi-planar, multi-contrast, and multi-time point imaging review were established, ensuring reproducibility in measuring plaque morphology. A novel CE map was introduced to objectively quantify plaque CE intake. In one of the first prospective studies tracking intracranial atherosclerosis evolution using 3D VWI, this research observed the evolution of intracranial plaques over a 1-year follow-up period and found that plaques progressing over time demonstrated inward remodeling and lumen loss, while regressing plaques exhibited luminal expansion. Significantly, plaque CE and diabetes mellitus were identified as biomarkers predicting plaque progression. Secondly, tailored analysis pipelines were proposed for two complementary carotid VWI contrasts, enabling consistent measurements of vessel thickness, plaque burden, and IPH. Through a long-term prospective study spanning up to 6 years with up to 5 scans per patient, our research revealed the systemic nature of atherosclerosis, characterized by bilateral plaque evolution symmetry. IPH emerged as a significant driver of plaque progression, capable of disrupting bilateral symmetry and accelerating plaque burden increase. These findings underscore the critical importance of integrating IPH assessment into clinical evaluations of plaque progression. Collectively, these studies establish robust quantitative methods for analyzing vessel wall imaging and provide critical insights into atherosclerotic disease progression in cerebrovascular territories. By establishing the clinical significance of imaging biomarkers like contrast enhancement and intraplaque hemorrhage, this research enables improved risk stratification and monitoring of treatment response, potentially advancing stroke prevention strategies.