Plaque Morphologic Quantification Reliability of 3D Whole-Brain Vessel Wall Imaging in Patients With Intracranial Atherosclerotic Disease: A Comparison With Conventional 3D Targeted Vessel Wall Imaging.

ABSTRACT

BACKGROUND: Three-dimensional (3D) whole-brain vessel wall imaging (VWI) has demonstrated exquisite image quality for delineating intracranial atherosclerotic disease (ICAD) and reliability for quantifying normal vessel dimensions. However, its reliability in quantifying plaque morphology remains unknown. PURPOSE: To evaluate the plaque morphologic quantification reliability of 3D whole-brain VWI in patients via comparison with 3D targeted VWI and 2D turbo spin-echo (TSE). STUDY TYPE Prospective. POPULATION Thirty-three patients with symptomatic ICAD. FIELD STRENGTH/SEQUENCE A 3D and 2D TSE acquired at 3.0 T. ASSESSMENT Each participant underwent two VWI sessions with an interval of 7-10 days. Three readers identified in consensus all the plaques on both whole-brain and targeted 3D VWI. Their lumen and vessel wall area and volume, plaque burden, percent stenosis, and vessel wall remodeling were measured for by two independent readers. At each culprit plaque determined by a radiologist, the lumen and vessel wall area, plaque burden, plaque-to-wall contrast ratio (CR), and plaque enhancement ratio (ER) were measured for 2D and 3D VWI methods. STATISTICAL TESTS Intra-class correlation coefficient (ICC) was used to evaluate for 3D VWI's interobserver/intraobserver agreement, interscan repeatability, and agreement with 2D TSE in each plaque morphologic measurements. Paired t test was performed for detecting the differences in plaque-to-wall CR and plaque ER between the two 3D methods. RESULTS: Eighty-four plaques were detected by both 3D VWI methods. Whole-brain VWI provided excellent interobserver/intraobserver agreement (ICCs 0.79-0.99/0.95-0.99), interscan repeatability (ICCs 0.85-0.99), agreement with 2D TSE (ICC 0.80-0.94) in all morphologic measurements. ICCs of whole-brain VWI (0.79-0.99) were higher or equal to those of targeted VWI (0.76-0.99). The plaque-to-wall CR and plaque ER were significantly higher on whole-brain VWI than on targeted VWI. DATA CONCLUSION: The 3D whole-brain VWI provides excellent interobserver/intraobserver agreement, interscan repeatability, and agreement with 2D TSE in plaque morphologic quantification of ICAD and outperforms 3D targeted VWI. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE 2.