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Background and Purpose: We investigated the baseline demographics of patients with severe unilateral atherosclerotic stenosis of the middle cerebral artery (MCA) using multimodal MRI and evaluated the haemodynamic impairments and plaque characteristics of patients who had a recurrent stroke., Materials and Methods: We retrospectively recruited consecutive patients with severe unilateral atherosclerotic MCA stenosis who underwent arterial spin labelling (ASL) with postlabelling delay (PLD) of 1.5 and 2.5 s, and vessel wall MRI. For each PLD, cerebral blood flow (CBF) maps were generated. Hypoperfusion volume ratio (HVR) from 2 PLD CBF was calculated. An HVR value ≥50% was considered as severe HVR. Plaque areas, plaque burden, plaque length and remodelling index were measured. Plaque enhancement at maximal lumen narrowing site were graded. Baseline clinical and imaging characteristics were compared between patients with (event+) and without (event-) 1 year ischaemic events., Results: Forty-three patients (47.23±12.15 years; 28 men) were enrolled in this study. Seven patients had an HVR ≥50%. During the 1-year follow-up, 7 patients had experienced a recurrent stroke. HVR were significantly higher in the event+ than event- (53.17%±29.82% vs 16.9%±15.57%, p=0.0002), whereas no significant difference was detected in plaque areas, plaque burden, remodelling index, plaque length and plaque enhancement grade. The multivariable analysis revealed that a severe HVR was significantly associated with a recurrent stroke (Odds ratio=12.93, 95% confidence interval 1.57 to 106.24, p=0.017) after adjusted by hypertension and smoking., Conclusion: HVR obtained from two PLD ASL may be a useful imaging predictor of recurrent stroke., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Global brain health has gained increasing attention recently. Imaging markers of brain frailty have been related to functional outcomes in previous studies on anterior circulation; however, little data are available on imaging markers and posterior circulation. Purpose: To investigate the impact of brain frailty on functional outcomes in patients with acute perforating artery infarction (PAI) of the posterior circulation. Study Type: Prospective. Population: One hundred patients (60.78 ± 9.51 years, 72% men) with acute posterior circulation PAI (determined by diffusion‐weighted magnetic resonance imaging (MRI)/time‐of‐flight MR angiography). Field Strength/Sequence: T1‐ and T2‐weighted fast spin echo, T2‐weighted fluid‐attenuated inversion recovery, diffusion‐weighted echo planar, gradient echo (susceptibility‐weight imaging), and 3D time‐of‐flight MR angiography sequences at 3.0 T. Assessment: Periventricular and deep white matter hyperintensities (WMH), enlarged perivascular spaces (EPVS) in the basal ganglia and centrum semiovale area, lacunes, cerebral microbleeds (CMB), and total brain frailty score by calculating the above imaging characters were rated visually by three radiologists with 9, 10, and 11 years of experience and one neuroradiologist with 12. Infarction volume was assessed using baseline diffusion‐weighted imaging (DWI) data obtained within 24 hours of symptom onset. A modified Rankin Scale (mRS) score >1 on day 90 defined an adverse functional outcome. Associations between the imaging markers of brain frailty and functional outcomes were assessed. Statistical Tests: Fisher's exact test, Mann–Whitney U test, and multivariable binary logistic regression. A P value <0.05 was considered statistically significant. Results: Adverse prognoses (mRS > 1) were observed in 34 (34%) patients. Infarction volume, periventricular WMH, deep WMH, basal ganglia EPVS, CMB, and the brain frailty score were significantly associated with adverse functional outcomes. An increased brain frailty score was significantly associated with unfavorable mRS score on day 90 (odds ratio 1.773, 95% confidence interval 1.237–2.541). Data Conclusion: Advanced MRI imaging markers of brain frailty, individually or combined as a total brain frailty score, were associated with worse functional outcomes after acute posterior circulation PAI. Level of Evidence: 3 Technical Efficacy: Stage 3 [ABSTRACT FROM AUTHOR]

Purpose: To determine the efficacy of susceptibility-weighted imaging (SWI) in the differential diagnosis between basal ganglia (BG) infarct-like early stage intracranial ectopic germinomas (IEGs) and subacute lacunar infarct (SLI). Materials and Methods: Six children with early stage BG IEGs displaying an infarct-like episode proven by pathology and eight children with BG SLI proven by clinic and vascular imaging were investigated retrospectively. On SWI, the contrast-to-noise ratio (CNR) in abnormal signal intensity regions was calculated and compared between the two groups. Results: For both IEGs and SLI the BG lesions were invisible or showed slight hyperintensity/hypointensity on T1-weighted images and diffusion-weighted images, patchy slight hyperintensity on T2-weighted images without mass effect, and variable enhancement on postcontrast magnetic resonance imaging (MRI). On SWI, obvious hypointensity in BG lesions and pineal gland (PG) was found in IEG patients but unremarkable in SLI patients. The CNRs of BG lesions and PG were significantly higher in IEG patients compared with those in SLI patients ( P < 0.01). Conclusion: SWI is useful in differentiating IEGs from SLI when clinical symptoms and conventional MRI manifestations overlap in these two conditions. PG may be involved with tumor, although it is normal on conventional MRI in patients with IEGs. J. Magn. Reson. Imaging 2012;36:92-98. © 2012 Wiley Periodicals Inc. [ABSTRACT FROM AUTHOR]