Diagnostic Impact of Intracranial Vessel Wall MRI on Ischemic Stroke Etiology in Young Adults.
6 affiliations
- 1Radiology Centre, North Estonia Medical Centre, Tallinn, Estonia.
- 2Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.
- 3Confido Medical Centre, Tallinn, Estonia.
- 4Department of Neurology, North Estonia Medical Centre, Tallinn, Estonia.
- 5Department of Radiology, Tartu University Hospital, Tartu, Estonia.
- 6Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia.
Abstract
Background
Intracranial vessel wall imaging (VWI) enables visualization of arterial wall pathology and may improve etiologic classification of ischemic stroke, but existing evidence is largely based on retrospective studies. We aimed to prospectively evaluate the diagnostic impact of VWI in young stroke patients.Methods
In this two-centre study, consecutive patients aged 18-59 years with acute ischemic stroke in the middle cerebral or anterior choroidal artery territory underwent contrast-enhanced VWI within 2 weeks of stroke onset. Stroke etiology was assessed using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) and the Causative Classification of Stroke (CCS) classifications before and after incorporating VWI findings. Changes in etiologic classification and predictors of diagnostic change were analyzed.Results
Sixty-nine patients were included (median age 53 years, 72% male). Incorporation of VWI findings resulted in a change in etiologic classification in 9/69 (13%) patients according to TOAST and 10/69 (14%) according to CCS. For TOAST classification, the proportion of large artery atherosclerosis increased from 17% to 28%, while cryptogenic stroke decreased from 22% to 14%. Baseline cryptogenic stroke was associated with etiologic reclassification after adjustment for age and sex (OR 7.8, 95% CI: 1.2-49.7; p = 0.029).Conclusions
VWI frequently identified intracranial atherosclerotic plaques not evident on luminal imaging, leading to etiologic reclassification predominantly toward large artery atherosclerosis. These findings suggest incremental diagnostic value in the etiologic assessment of young stroke, particularly in cryptogenic cases. Larger prospective studies are warranted to determine its role in routine diagnostic algorithms.
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BibTeX
@article{reimand2026diagnostic,
title = {{Diagnostic Impact of Intracranial Vessel Wall MRI on Ischemic Stroke Etiology in Young Adults.}},
author = {Juhan Reimand and Siim Schneider and Riina Vibo and Liisa Kõrv and Dagmar Loorits and Karl Jõgi and Teele Tuularu and Nele Taba and Kateriine Orav and Janika Kõrv},
journal = {European journal of neurology},
year = {2026},
month = oct,
doi = {10.1111/ene.70795},
url = {https://europepmc.org/article/MED/42899435},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Diagnostic Impact of Intracranial Vessel Wall MRI on Ischemic Stroke Etiology in Young Adults.
AU - Juhan Reimand
AU - Siim Schneider
AU - Riina Vibo
AU - Liisa Kõrv
AU - Dagmar Loorits
AU - Karl Jõgi
AU - Teele Tuularu
AU - Nele Taba
AU - Kateriine Orav
AU - Janika Kõrv
PY - 2026
DA - 2026/10/01
JO - European journal of neurology
DO - 10.1111/ene.70795
UR - https://europepmc.org/article/MED/42899435
AB - Background Intracranial vessel wall imaging (VWI) enables visualization of arterial wall pathology and may improve etiologic classification of ischemic stroke, but existing evidence is largely based on retrospective studies. We aimed to prospectively evaluate the diagnostic impact of VWI in young stroke patients.Methods In this two-centre study, consecutive patients aged 18-59 years with acute ischemic stroke in the middle cerebral or anterior choroidal artery territory underwent contrast-enhanced VWI within 2 weeks of stroke onset. Stroke etiology was assessed using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) and the Causative Classification of Stroke (CCS) classifications before and after incorporating VWI findings. Changes in etiologic classification and predictors of diagnostic change were analyzed.Results Sixty-nine patients were included (median age 53 years, 72% male). Incorporation of VWI findings resulted in a change in etiologic classification in 9/69 (13%) patients according to TOAST and 10/69 (14%) according to CCS. For TOAST classification, the proportion of large artery atherosclerosis increased from 17% to 28%, while cryptogenic stroke decreased from 22% to 14%. Baseline cryptogenic stroke was associated with etiologic reclassification after adjustment for age and sex (OR 7.8, 95% CI: 1.2-49.7; p = 0.029).Conclusions VWI frequently identified intracranial atherosclerotic plaques not evident on luminal imaging, leading to etiologic reclassification predominantly toward large artery atherosclerosis. These findings suggest incremental diagnostic value in the etiologic assessment of young stroke, particularly in cryptogenic cases. Larger prospective studies are warranted to determine its role in routine diagnostic algorithms.
SN - 1351-5101
SN - 1468-1331
ER -