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LETTERS How Far Can We Take Vessel Wall MRI for Intracranial Atherosclerosis? The Tissue is Still the Issue e read with great interest the recent article by Zwartbol et like remodeling pattern, enhancement, fibrous cap thickness, 1 2 Wal , and the accompanying commentary by Dr Chan. proximity to perforator ostia, intraplaque hemorrhage, or lipid- While the data from the SMART-MR cohort add to the body of rich necrotic core volume. Using vwMRI to merely identify the research on intracranial vessel wall MR imaging (vwMRI) studies, presence of ICAD misses an opportunity to better characterize we have concerns with the interpretation of the results, specifi- the disease. cally that the findings do not support “adifferent etiology” Another limitation of the methodology in Zwartbol et al is between intracranial (ICAD) and extracranial (ECAD) athero- identification of ICAD burden regardless of symptomatology. sclerosis. While vwMRI allows us to visualize disease in the The prevalence of ICAD is rather high, but most lesions prove vessel walls themselves, this provides only a snapshot of a harmless. The advantage of the granularity of vwMRI is that it dynamic process (atherogenesis) that is years-to-decades in could potentially distinguish the multiple ways ICAD can cause the
American Journal of Neuroradiology – American Journal of Neuroradiology
Published: May 1, 2020
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