Vessel Wall Imaging in Intracranial Atherosclerosis

Intracranial atherosclerosis is a leading cause of stroke worldwide, characterised by the build-up of lipid-rich plaques within the walls of cerebral arteries. Traditional angiographic techniques assess luminal narrowing but provide limited insight into the vessel wall itself. Vessel wall imaging employs specialised magnetic resonance sequences to visualise plaque composition, wall thickening and contrast uptake, revealing features of inflammation, neovascularisation and remodelling that are hidden on conventional scans. By distinguishing stable from vulnerable lesions, vessel wall imaging informs risk stratification and guides personalised therapies, such as antiplatelet regimens or endovascular intervention. Advances in spatial resolution, blood-suppression techniques and contrast protocols have transformed research and clinical practice, enabling detailed assessment of plaque morphology, enhancement patterns and vessel remodelling. These developments promise earlier detection of high-risk plaques, improved monitoring of therapeutic response and deeper understanding of disease mechanisms across diverse patient populations.

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Vessel Wall Imaging in Intracranial Atherosclerosis publication trend

The graph below shows the total number of articles in vessel wall imaging in intracranial atherosclerosis across all publications each year (not limited to Nature Index journals).

Technical terms

Vessel wall imaging: MRI techniques designed to visualise the arterial wall structure and detect plaque components beyond lumen stenosis.

High-resolution MRI: Imaging sequences with submillimetre spatial resolution that allow detailed delineation of vessel wall morphology.

Plaque enhancement: Increased uptake of contrast agent in an atherosclerotic lesion, indicative of inflammation or neovascularisation.

Positive remodelling: Outward expansion of the arterial wall in response to plaque growth, preserving lumen diameter despite plaque burden.

Culprit plaque: A specific atherosclerotic lesion identified as responsible for clinical ischaemic events such as stroke or transient ischaemic attack.

Normalized wall index: A quantitative ratio expressing plaque plus wall thickness relative to overall vessel size, used to assess plaque burden.

References

1. The incomplete circle of Willis is associated with vulnerable intracranial plaque features and acute ischemic stroke. Journal of Cardiovascular Magnetic Resonance (2023).
2. Incremental value of enhanced plaque length for identifying intracranial atherosclerotic culprit plaques: a high-resolution magnetic resonance imaging study. Insights into Imaging (2023).
3. Intracranial Vessel Wall MRI: Principles and Expert Consensus Recommendations of the American Society of Neuroradiology. American Journal of Neuroradiology (2016).