Intracranial atherosclerosis: Correlation between in-vivo 3T high resolution MRI and pathology

- In an intracranial stenosis case, we compared in-vivo MRI to post-mortem pathology.
- Extracranial carotid MRI signal characteristics were used to identify plaque features.
- MRI and pathology showed lipid, fibrous tissue, and calcium in intracranial plaque.

Background: High-resolution MRI (HRMRI) is a promising tool for studying intracranial atherosclerotic disease (ICAD) in-vivo, but its use to understand the pathophysiology of ICAD has been limited by a lack of correlation between MRI signal characteristics and pathology in intracranial arteries. Description of case: A patient with symptomatic left cavernous carotid stenosis underwent 3T HRMRI and died 4 days later. In-vivo HRMRI and postmortem histopathology images were compared. MRI signal characteristics consistent with atherosclerotic plaque composed of lipid and loose matrix, fibrous tissue, and calcium were correlated with pathology findings. Intraplaque hemorrhage was not present on HRMRI or pathology. Conclusions: This report demonstrates correlation between atherosclerotic plaque components visualized on 3T HRMRI images obtained in-vivo and pathological specimens of a symptomatic ICAD plaque, providing an important step in developing HRMRI as an in-vivo research tool to understand ICAD pathology.