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Purpose <p>The etiology of intracranial arterial occlusion (plaque vs. thrombus) dictates treatment but is challenging to determine using conventional imaging. We aimed to compare the diagnostic performance of high-resolution vessel wall magnetic resonance imaging (HR-VWI) and spectral CT (SCT) for this differentiation.</p> Methods <p>This retrospective study included 108 patients with cerebral infarction and intracranial arterial occlusion, classified into an HR-VWI group (<i>n</i> = 54) and an SCT group (<i>n</i> = 54) based on the first-line imaging modality. Using postoperative histopathology or multidisciplinary clinical consensus as the reference standard, the diagnostic performances of both techniques in differentiating plaque from thrombotic occlusion were compared. The quantitative parameters of SCT were analyzed.</p> Results <p>The overall diagnostic accuracy of HR-VWI and SCT was comparable (90.74% vs. 94.44%). However, they exhibited complementary diagnostic strengths: HR-VWI demonstrated higher sensitivity in diagnosing plaque occlusion (100% vs. 86.96%), whereas SCT showed superior sensitivity in diagnosing thrombotic occlusion (100% vs. 84.62%). Quantitative analysis of SCT revealed that the standardized iodine concentration (nIC), effective atomic number (Zeff), and energy spectrum curve slope (λHU) in the plaque occlusion group were significantly higher than those in the thrombotic occlusion group (all <i>p</i> &lt; 0.05), with nIC exhibiting the best diagnostic efficacy (AUC = 0.9355).</p> Conclusions <p>HR-VWI and SCT are highly accurate and complementary for determining occlusion etiology. HR-VWI excels in plaque characterization, whereas SCT, with rapid acquisition and quantitative biomarkers like nIC, is advantageous for thrombus identification in acute settings.</p>

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High-resolution vessel wall MRI and spectral CT in intracranial arterial occlusion: comparative diagnostic performance for plaque vs. thrombus

  • 期刊论文

  • 发表日期：

    2026年5月2日

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  • Liangfan Jia,
  • Xiaona Li,
  • Yingshuai Zhang,
  • Yifan Liu,
  • Hongran Liu,
  • Cuicui Liu,
  • Zhigang Peng

摘要

Purpose

The etiology of intracranial arterial occlusion (plaque vs. thrombus) dictates treatment but is challenging to determine using conventional imaging. We aimed to compare the diagnostic performance of high-resolution vessel wall magnetic resonance imaging (HR-VWI) and spectral CT (SCT) for this differentiation.

Methods

This retrospective study included 108 patients with cerebral infarction and intracranial arterial occlusion, classified into an HR-VWI group (n = 54) and an SCT group (n = 54) based on the first-line imaging modality. Using postoperative histopathology or multidisciplinary clinical consensus as the reference standard, the diagnostic performances of both techniques in differentiating plaque from thrombotic occlusion were compared. The quantitative parameters of SCT were analyzed.

Results

The overall diagnostic accuracy of HR-VWI and SCT was comparable (90.74% vs. 94.44%). However, they exhibited complementary diagnostic strengths: HR-VWI demonstrated higher sensitivity in diagnosing plaque occlusion (100% vs. 86.96%), whereas SCT showed superior sensitivity in diagnosing thrombotic occlusion (100% vs. 84.62%). Quantitative analysis of SCT revealed that the standardized iodine concentration (nIC), effective atomic number (Zeff), and energy spectrum curve slope (λHU) in the plaque occlusion group were significantly higher than those in the thrombotic occlusion group (all p < 0.05), with nIC exhibiting the best diagnostic efficacy (AUC = 0.9355).

Conclusions

HR-VWI and SCT are highly accurate and complementary for determining occlusion etiology. HR-VWI excels in plaque characterization, whereas SCT, with rapid acquisition and quantitative biomarkers like nIC, is advantageous for thrombus identification in acute settings.