Lipid-Rich Necrotic Core of Basilar Artery Atherosclerotic Plaque: Contrast-Enhanced Black Blood Imaging on Vessel Wall Imaging

Purpose: We wished to evaluate the lipid-rich necrotic core (LRNC) using contrast-enhanced T1-weighted (CE-T1W) black-blood (BB) imaging for vessel walls. Methods: Ninety-five patients with basilar artery (BA) stenosis who underwent magnetic resonance angiography between January 2016 and August 2018 were enrolled into this present study. CE-T1W BB imaging was considered as a reference method for identifying an LRNC. Results: Ten (10.5%) patients were identified as having an LRNC on CE-T1W BB imaging. Of these patients, 9 had acute symptoms. The extent of stenosis in patients with an LRNC on CE-T1W BB imaging was significantly greater than that of patients without an LRNC (p < 0.001). The maximum wall thickness in patients with an LRNC on CE-T1W imaging was significantly thicker than that of patients without an LRNC (p = 0.008). Conclusions: Identification of an LRNC on CE-T1W BB imaging was associated with high-grade stenosis and massive plaque burden from BA atherosclerosis.