Vessel wall enhancement in vertebrobasilar dolichoectasia is associated with posterior circulation infarction: An observational study based on high-resolution magnetic resonance imaging

Background: Posterior circulation infarction (PCI) is the most common manifestation of vertebrobasilar dolichoectasia (VBD). Vessel wall enhancement (VWE) in high-resolution magnetic resonance imaging (HR-MRI) is associated with ischemic stroke. Objectives: This study aims to evaluate different quantitative VWE parameters in identifying PCI in VBD patients by comparing the sensitivity of each VWE parameter. The associated factors of PCI and VWE were also identified. Methods: Patients with VBD who received HR-MRI were retrospectively analyzed and divided into PCI and non-PCI groups. Morphological parameters of VBD were measured using magnetic resonance angiography. VWE parameters, including arterial-to-pituitary stalk contrast ratio (CRstalk), arterial enhancement index, and arterial enhancement ratio, were extracted and calculated. The receiver-operating characteristic curve was used to compare the sensitivity of VWE parameters in discriminating PCI. The independent factors associated with PCI and VWE were investigated. Results: A total of 140 patients with VBD were included. Forty patients (28.6 %) had PCI. CRstalk with the average signal intensity (CRstalk-avg) had the highest sensitivity in identifying PCI with an area under curve value of 0.783 and a cut-off value of 0.47. CRstalk-avg (OR = 2.908, p < 0.001) and basilar artery tortuosity index (BATI) (OR = 1.391, p = 0.033) were independently associated with PCI. The independent associated factors of VWE were BA diameter (OR = 4.273, p < 0.001), BATI (OR = 1.040, p = 0.032), and hyperlipidemia (OR = 3.040, p = 0.018). Conclusion: CRstalk-avg may be the most sensitive parameter for quantifying VWE to identify PCI in patients with VBD, and it is also independently associated with PCI. BA diameter, BATI, and hyperlipidemia are independently associated with VWE.