Visualization of basilar artery atherosclerotic plaques by conventional T2-weighted magnetic resonance imaging: A case-control study

OBJECTIVE: In vivo visualization of intracranial atherosclerotic plaque has been performed only with high-resolution magnetic resonance imaging (HRMR). We investigated whether atherosclerotic plaque of the basilar artery (BA) can be identified in conventional magnetic resonance imaging (MRI). METHODS: Patients with acute ischemic stroke who had BA stenosis (“symptomatic BAA”) were retrospectively recruited using the prospective stroke registry. In the HRMR databank, subjects without BA stenosis were recruited and classified as those with silent plaque (“silent BAA”) and without any plaque (“normal controls”). Outer diameter of the BA and T2 plaque sign (an eccentric or complete obscuration of normal flow-void) within the BA were assessed by two blinded raters using conventional T2 MRI. RESULTS: Seventy-five patients with symptomatic BAA, 40 with asymptomatic BAA, and 36 normal controls were included in the study. Maximal BA diameter was significantly larger in symptomatic BAA patients with <30%, 30–50%, 50–70%, and >70% stenosis (all p<0.01 in each subgroup) and silent BAA subjects (p = 0.018) than controls. T2 plaque signs were present in 46 (61.3%) patients with symptomatic BAA and 6 (14.6%) subjects with asymptomatic BAA, while none in normal controls (p <0.001 and 0.057, respectively). Detection rates were increased with an increase in stenosis degree (25.0% in <30% stenosis, 57.9% in 30–50% stenosis, 38.5% in 50–70% stenosis, 92.3% in 70–99% stenosis, and 100.0% in occlusion). CONCLUSIONS: Our data suggest that BA atherosclerosis can be detected by conventional MRI. When the use of HRMR is limited, conventional MR imaging may give additive information to clinicians.