Abstract DP311: One-Stop Head-Neck-Aortic Vessel Wall MRI: A New Imaging Approach for Assessing Supracardiac Atherosclerosis in Stroke

Background: Supracardiac atherosclerosis—including carotid, vertebrobasilar, intracranial, and aortic arch arteries—is a major cause of stroke. While vessel wall MRI (vwMRI) can assess plaques, current techniques lack full head-neck-aortic coverage and efficiency. Purpose: To develop and validate a rapid, comprehensive head-neck-aortic vwMRI approach for assessing supracardiac atherosclerosis, comparing it with supra-aortic CTA and evaluating its value in identifying causes of embolic stroke of undetermined source (ESUS). Materials and Methods: A new non-contrast 3D head-neck-aortic vwMRI approach was developed for assessing supracardiac vasculature in ischemic stroke patients. It integrates a multi-coil hardware system with 3D black- and gray-blood vwMRI, accelerated by a novel neural network-based technique, achieving about 15-minute total scan time(Figure 1). Plaque vulnerabilities, stenosis, and stroke etiologies were compared between vwMRI and supra-aortic CTA. Results: From October 2024 to March 2025, 108 patients (mean age, 56 ± 14 years; 89 male) with ischemic stroke or transient ischemic attack underwent both vwMRI and supra-aortic CTA. vwMRI detected 301 plaques in 88 patients, versus 246 plaques in 75 patients by CTA (κ=0.583, p