Association between three-dimensional high-resolution MRI indicators and risk of vascular events in intracranial atherosclerotic disease patients

OBJECTIVE: Intracranial atherosclerotic disease (ICAD) is a leading cause of ischemic stroke worldwide. The objective of this study is to evaluate the association of three-dimensional high-resolution MRI (3D HR-MRI) characteristics related to intracranial plaques with the risk of vascular events in ICAD patients. METHODS: A comparison of demographics and intracranial plaque characteristics was conducted on intracranial atherosclerotic plaques in 43 asymptomatic ICAD patients, 31 patients with transient ischemic attack (TIA), and 113 patients with acute ischemic stroke (AIS). Univariate and multivariate logistic regression analyses were employed to identify specific plaque characteristics associated with these vascular events. Receiver operating characteristic curves were generated to illustrate the discriminatory performance of these plaque features. RESULTS: Significant differences in irregular surface, grade 2 enhancement, signal intensity (SI), wall contrast ratio (CR), remodeling index, normalized wall index, 3D average normalized wall index, plaque length, and volume were observed between the asymptomatic group and the AIS group (P<0.05). When comparing the asymptomatic group to the TIA group, statistically significant disparities were noted in plaque irregularity, plaque length, and plaque volume (P<0.05). Conversely, comparing TIA and AIS groups, only plaque wall CR demonstrated a statistically meaningful difference (P<0.05). Multivariable logistic regression analysis identified increased plaque volume as an independent risk factor for ICAD-related vascular events leading to TIA (OR 1.01, 95% CI 1.00 to 1.03, P=0.02). The efficacy of plaque volume in differentiating between asymptomatic patients and those presenting with TIA was substantial, yielding an area under the curve (AUC) value of 0.74 (95% CI 0.59 to 0.89). Moreover, plaque grade 2 enhancement (OR 6.31, 95% CI 1.70 to 31.63, P=0.011), remodeling index (OR 15.64, 95% CI 2.25 to 148, P=0.009), and plaque volume (OR 1.01, 95% CI 1.00 to 1.02, P=0.003) emerged as independent predictors for the occurrence of AIS linked to ICAD. A comprehensive model that integrates these features achieved a remarkable predictive capability (AUC 0.83, 95% CI 0.76 to 0.91). CONCLUSION: The 3D HR-MRI characteristics of atherosclerotic plaques exhibited notable variations across different vascular events and can be identified through distinct imaging markers, serving as a basis for studying the pathogenesis of ICAD.