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Advanced Neurology

ORIGINAL RESEARCH ARTICLE
Fried-Breadstick sign: A novel marker for

healthy vasculature in magnetic resonance
angiography

1
1,2
Yannan Yu , Yu-Yuan Xu , Xue Man , Ming-Li Li , Bo Hou , Shan Gao ,
1
1
3
3
3
Feng Feng , David S Liebeskind , and Wei-Hai Xu *
1
2
1 Department of Neurology, State Key Laboratory of Complex Severe and Rare Disease, Peking
Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
2 Neurovascular Imaging Research Core and UCLA Stroke Center, Los Angeles, California, USA
3 Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing, China
Abstract
The Fried-Breadstick sign is characterized as a continuous signal loss at the center
of the intracranial internal carotid artery (ICA) on time-of-flight magnetic resonance
angiography (TOF-MRA). In this study, we present a novel imaging marker on TOF-MRA
and investigate its potential association with ICA-middle cerebral artery (ICA-MCA)
atherosclerosis and ischemic stroke. Vessel wall magnetic resonance imaging data
were obtained from patients with recent clinical stroke or asymptomatic patients
*Corresponding Author: with suspected middle cerebral artery (MCA) atherosclerosis, covering the period
Wei-Hai Xu from January 2007 to August 2015. We conducted a comparative analysis of ICA
(xuwh@pumch.cn) stenosis, MCA atherosclerosis and stenosis degree, and the terminal ICA bifurcation
Citation: Yu Y, Li M, Gao S, et al., angle between ICA-MCAs with and without the Fried-Breadstick sign, involving a
2023, Fried-Breadstick sign: A novel total of 1,005 ICA-MCAs from 553 patients. The Fried-Breadstick sign exhibited a
marker for healthy vasculature in
magnetic resonance angiography. higher prevalence in non-to-mild stenotic ICAs (57.5% vs. 9.8% in severely stenotic
Adv Neuro, 2(4): 1238. ICA, P < 0.001) and plaque-free MCAs (53.2% vs. 26.6% in MCAs with plaque,
https://doi.org/10.36922/an.1238 P < 0.001). Factors independently associated with the presence of the Fried-
Received: July 4, 2023 Breadstick sign included MCA stenosis degree (odds ratio [OR]: 0.85/10% increase,
95% confidence interval [CI]: 0.80 – 0.90), ICA stenosis (compared to non-to-mild
Accepted: November 28, 2023
stenosis, moderate stenosis: OR: 0.39, 95% CI: 0.28 – 0.54, severe stenosis: OR: 0.10,
Published Online: December 21, 95% CI: 0.06 – 0.17), and terminal ICA bifurcation angle (OR: 0.86/10° increase,
2023 95% CI: 0.79 – 0.93). In atherosclerotic MCAs without luminal narrowing, the
Copyright: © 2023 Author(s). Fried-Breadstick sign was also less frequently observed than in plaque-free MCAs
This is an Open-Access article (34.6% vs. 53.2%, P = 0.012). In conclusion, the presence of the Fried-Breadstick
distributed under the terms of the
Creative Commons Attribution sign is associated with healthier ICA-MCAs devoid of stenosis or plaque. The Fried-
License, permitting distribution, Breadstick sign may signify healthy ICA-MCA hemodynamics, serving as a potential
and reproduction in any medium, screening tool for intracranial atherosclerosis without incurring additional cost or
provided the original work is
properly cited. risk.
Publisher’s Note: AccScience
Publishing remains neutral with Keywords: Intracranial atherosclerosis; Middle cerebral artery; Hemodynamics; Vessel
regard to jurisdictional claims in
published maps and institutional wall magnetic resonance imaging; Magnetic resonance angiography
affiliations.

Volume 2 Issue 4 (2023) 1 https://doi.org/10.36922/an.1238