Digital subtraction angiography (DSA) remains the gold standard for assessment of intracranial artery stenosis. However, it is invasive and may miss lesions without luminal stenosis due to vessel wall outward remodeling. We compared 3D black-blood MRI (SPACE) with DSA in 74 intracranial plaques, and found SPACE was in good agreement with DSA for stenosis quantification (ICC=0.82), but the plaque was longer in SPACE than DSA. Moreover, SPACE detected 28 more plaques than DSA, and 14 of 28 plaques showed enhancement. SPACE is promising for evaluating the severity of intracranial atherosclerosis and may improve patient management.
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