Advances in differential diagnosis of cerebrovascular diseases in magnetic resonance imaging: a narrative review

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Abstract

Background and Objective

Cerebrovascular diseases (CVDs), particularly cerebral stroke, remain a primary cause of disability and death worldwide. Accurate diagnosis of CVDs is essential to guide therapeutic decisions and foresee the prognosis. Different CVDs have different pathological processes while they have many signs in common with some other brain diseases. Thus, differential diagnoses of strokes from other primary and secondary CVDs are especially important and challenging.

Methods

This review is composed mainly based on searching PubMed articles between September, 2013 and December 26, 2022 in English.

Key Content and Findings

Neuroimaging is a powerful tool for CVD diagnosis including cerebral angiography, ultrasound, computed tomography, and positron emission tomography as well as magnetic resonance imaging (MRI). MRI excels other imaging techniques by its features of non-invasive, diverse sequences and high spatiotemporal resolution. It can detect hemodynamic, structural alterations of intracranial arteries and metabolic status of their associated brain regions. In acute stroke, differential diagnosis of ischemic from hemorrhagic stroke and other intracranial vasculopathies is a common application of MRI. By providing information about the pathological characteristics of cerebral diseases exhibiting different degrees of behavioral alterations, cognitive impairment, motor dysfunction and other indications, MRI can differentiate strokes from other primary CVDs involving cerebral small vessels and identify vascular dementia from hyponatremia, brain tumors and other secondary or non-primary CVDs.

Conclusions

Recent advances in MRI technology allow clinical neuroimaging to provide unique reference for differentiating many previously inconclusive CVDs. MRI technology is worthy of full exploration while breaking its limitations in clinical applications should be considered.

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Most cited references 141

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Slow expansion of multiple sclerosis iron rim lesions: pathology and 7 T magnetic resonance imaging

Assunta Dal-Bianco, Günther Grabner, Claudia Kronnerwetter … (2016)

In multiple sclerosis (MS), iron accumulates inside activated microglia/macrophages at edges of some chronic demyelinated lesions, forming rims. In susceptibility-based magnetic resonance imaging at 7 T, iron-laden microglia/macrophages induce a rim of decreased signal at lesion edges and have been associated with slowly expanding lesions. We aimed to determine (1) what lesion types and stages are associated with iron accumulation at their edges, (2) what cells at the lesion edges accumulate iron and what is their activation status, (3) how reliably can iron accumulation at the lesion edge be detected by 7 T magnetic resonance imaging (MRI), and (4) if lesions with rims enlarge over time in vivo, when compared to lesions without rims. Double-hemispheric brain sections of 28 MS cases were stained for iron, myelin, and microglia/macrophages. Prior to histology, 4 of these 28 cases were imaged at 7 T using post-mortem susceptibility-weighted imaging. In vivo, seven MS patients underwent annual neurological examinations and 7 T MRI for 3.5 years, using a fluid attenuated inversion recovery/susceptibility-weighted imaging fusion sequence. Pathologically, we found iron rims around slowly expanding and some inactive lesions but hardly around remyelinated shadow plaques. Iron in rims was mainly present in microglia/macrophages with a pro-inflammatory activation status, but only very rarely in astrocytes. Histological validation of post-mortem susceptibility-weighted imaging revealed a quantitative threshold of iron-laden microglia when a rim was visible. Slowly expanding lesions significantly exceeded this threshold, when compared with inactive lesions (p = 0.003). We show for the first time that rim lesions significantly expanded in vivo after 3.5 years, compared to lesions without rims (p = 0.003). Thus, slow expansion of MS lesions with rims, which reflects chronic lesion activity, may, in the future, become an MRI marker for disease activity in MS. Electronic supplementary material The online version of this article (doi:10.1007/s00401-016-1636-z) contains supplementary material, which is available to authorized users.

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Whole brain myelin mapping using T1- and T2-weighted MR imaging data

Marco Ganzetti, Nicole Wenderoth, Dante Mantini (2014)

Despite recent advancements in MR imaging, non-invasive mapping of myelin in the brain still remains an open issue. Here we attempted to provide a potential solution. Specifically, we developed a processing workflow based on T1-w and T2-w MR data to generate an optimized myelin enhanced contrast image. The workflow allows whole brain mapping using the T1-w/T2-w technique, which was originally introduced as a non-invasive method for assessing cortical myelin content. The hallmark of our approach is a retrospective calibration algorithm, applied to bias-corrected T1-w and T2-w images, that relies on image intensities outside the brain. This permits standardizing the intensity histogram of the ratio image, thereby allowing for across-subject statistical analyses. Quantitative comparisons of image histograms within and across different datasets confirmed the effectiveness of our normalization procedure. Not only did the calibrated T1-w/T2-w images exhibit a comparable intensity range, but also the shape of the intensity histograms was largely corresponding. We also assessed the reliability and specificity of the ratio image compared to other MR-based techniques, such as magnetization transfer ratio (MTR), fractional anisotropy (FA), and fluid-attenuated inversion recovery (FLAIR). With respect to these other techniques, T1-w/T2-w had consistently high values, as well as low inter-subject variability, in brain structures where myelin is most abundant. Overall, our results suggested that the T1-w/T2-w technique may be a valid tool supporting the non-invasive mapping of myelin in the brain. Therefore, it might find important applications in the study of brain development, aging and disease.

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Imaging of Intracranial Hemorrhage

Jeremy J. Heit, Michael Iv, Max Wintermark (2016)

Intracranial hemorrhage is common and is caused by diverse pathology, including trauma, hypertension, cerebral amyloid angiopathy, hemorrhagic conversion of ischemic infarction, cerebral aneurysms, cerebral arteriovenous malformations, dural arteriovenous fistula, vasculitis, and venous sinus thrombosis, among other causes. Neuroimaging is essential for the treating physician to identify the cause of hemorrhage and to understand the location and severity of hemorrhage, the risk of impending cerebral injury, and to guide often emergent patient treatment. We review CT and MRI evaluation of intracranial hemorrhage with the goal of providing a broad overview of the diverse causes and varied appearances of intracranial hemorrhage.

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Author and article information

Journal

Journal ID (nlm-ta): Quant Imaging Med Surg

Journal ID (iso-abbrev): Quant Imaging Med Surg

Journal ID (publisher-id): QIMS

Title: Quantitative Imaging in Medicine and Surgery

Publisher: AME Publishing Company

ISSN (Print): 2223-4292

ISSN (Electronic): 2223-4306

Publication date (Electronic): 22 February 2023

Publication date (Print): 01 April 2023

Volume: 13

Issue: 4

Pages: 2712-2734

Affiliations

[1 ]deptDepartment of Radiology , the Second Hospital of Jilin University , Changchun, China;

[2 ]deptDepartment of Neurosurgery , the Second Hospital of Jilin University , Changchun, China;

[3 ]deptDepartment of Internal Neurology , the Second Hospital of Jilin University , Changchun, China

Author notes

Contributions: (I) Conception and design: F Su, Q Yuan; (II) Administrative support: Q Yuan; (III) Provision of study materials or patients: F Su; (IV) Collection and assembly of data: X Li; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Fengbo Su. Department of Neurosurgery, the Second Hospital of Jilin University, No. 218 Ziqiang St., Changchun 130041, China. Email: sufengbo@ 123456jlu.edu.cn ; Qinghai Yuan. Department of Radiology, the Second Hospital of Jilin University, No. 218 Ziqiang St., Changchun 130041, China. Email: yqh@ 123456jlu.edu.cn .

Article

Publisher ID: qims-13-04-2712

DOI: 10.21037/qims-22-750

PMC ID: 10102759

PubMed ID: 37064346

SO-VID: 3407ab4d-6be4-4d4f-a4cd-0f110afd1d21

License:

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

Advances in differential diagnosis of cerebrovascular diseases in magnetic resonance imaging: a narrative review

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Abstract

Background and Objective

Methods

Key Content and Findings

Conclusions

Related collections

Stroke MRI

Most cited references 141

Slow expansion of multiple sclerosis iron rim lesions: pathology and 7 T magnetic resonance imaging

Whole brain myelin mapping using T1- and T2-weighted MR imaging data

Imaging of Intracranial Hemorrhage

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