Page 69 - AN-2-4

Advanced Neurology A novel marker for healthy intracranial arteries

logistic regression analysis for OR evaluation. A P < 0.05 3.3. Relationship between the Fried-Breadstick sign
was considered statistically significant for all tests, and and intracranial atherosclerosis
they were all two-sided. The FB sign occurred more frequently in non-to-mild

3. Results stenotic ICAs (57.5% vs. 31.6% vs. 9.8%, P < 0.001)
compared to moderately and severely stenotic ICAs. The
3.1. Demographic characteristics prevalence of the FB sign decreased as the ICA-MCA

Among 1538 patients in our database, 553 met the stenosis degree increased (Figure 3). Moreover, the FB
inclusion criteria, comprising 137 with a recent stroke in sign was more prevalent in plaque-free MCAs (53.2%
the MCA territory and 416 without a history of stroke or vs. 26.6%, P < 0.001) than in atherosclerotic MCAs. The
TIA (Table 1). The FB sign and ICA-MCAs were assessed FB sign exhibited a sensitivity of 53% and a specificity of
bilaterally for each patient. We excluded 101 MCAs due 73% for identifying plaque-free MCAs. Additionally, in
to occlusions, poor image quality, or a lack of vessel wall atherosclerotic MCAs without narrowing lumen (with
images. Ultimately, 1005 ICA-MCAs were included in the plaque detected on vessel wall MRI), the FB sign occurred
analysis (Table 2). less frequently than in plaque-free MCAs (34.6% vs. 53.2%,
P = 0.012).
3.2. Inter and intraobserver agreement
After adjustment for whether the new MRI protocol
The interobserver and intraobserver agreements for was used, factors independently associated with the
identifying the FB sign were 0.692 (95% CI: 0.544 – 0.841) presence of the FB sign included MCA stenosis degree
and 0.825 (95% CI: 0.699 – 0.951), respectively. Additionally, (OR: 0.85/10% increase, 95% CI: 0.80 – 0.90), ICA stenosis
the agreements for measuring luminal area were 0.919 (95% (compared to non-to-mild stenosis, moderate stenosis:
CI: 0.845 – 0.958) and 0.933 (95% CI: 0.872 – 0.96). OR: 0.39, 95% CI: 0.28 – 0.54, severe stenosis: OR: 0.10,
95% CI: 0.06 – 0.17), and bifurcation angle (OR: 0.86/10°
Table 1. Demographic and clinical data of patients (subjects) increase, 95% CI: 0.79 – 0.93) (Table 3). The probability
with and without stroke of the FB sign at different ICA and MCA stenosis degrees
is plotted in Figure S1. The results remain consistent with
Demographic and clinical Patients Patients P‑value
characteristic with stroke without the analysis in separate patient groups scanned with the 2
(n=137) stroke MRA protocols in the study period (Table S1).
(n=416)
3.4. Relationship between stroke patterns and the
Male (n [%]) 104 (75.9) 249 (59.0) 0.001 Fried-Breadstick sign
Age (x±SD years) 57±15 58±15 0.833
Hypertension (n [%]) 82 (59.9) 245 (58.9) 0.843 The FB sign occurred most frequently in small SSI
Dyslipidemia (n [%]) 59 (43.1) 196 (47.1) 0.410 (43.6%) compared with large SSI (37.5%, P = 0.6), non-
SSI (16.4%, P = 0.003), and asymptomatic MCAs (25.9%,
Diabetes (n [%]) 32 (23.4) 74 (17.8) 0.151 P = 0.017) (Figure 3). The FB sign had a sensitivity of
Current smoker (n [%]) 54 (39.4) 136 (32.6) 0.151 44% and a specificity of 74% for identifying small SSI in
Coronary artery disease (n [%]) 17 (12.5) 37 (8.9) 0.219 symptomatic patients. ICA-MCAs with small SSI also
showed a significantly lower MCA stenosis degree (23%,
Table 2. Distribution of ICA stenosis and atherosclerotic interquartile range [IQR]: 6 – 41%) compared with large
MCA SSI (37%, IQR: 22 – 65%, P = 0.02), non-SSI (62%, IQR:
45 – 79%, P < 0.001), and asymptomatic MCAs (35%, IQR:
ICA stenosis Atherosclerotic MCA P‑value 18 – 55%, P = 0.008). After adjusting for MCA stenosis
Plaque‑free Atherosclerotic degree and ICA stenosis, the FB sign is independently
MCA MCA (n=576)
(n=429) associated with small SSI (relative risk ratio: 5.35, 95%
Non-to-mild 259 (60.4) 197 (34.2) <0.001 CI: 1.48 – 19.33) but not large SSI (relative risk ratio: 2.36,
95% CI: 0.66 – 8.44) when compared to non-SSIs. The ICA
ICA stenosis (n [%]) stenosis was not significantly different among different
Moderate 118 (27.5) 186 (32.3) N/A infarct patterns.
ICA stenosis (n [%])
Severe 52 (12.1) 193 (33.5) N/A 4. Discussion
ICA stenosis (n [%])
Abbreviations: ICA: Internal carotid artery; MCA: Middle cerebral This study explored the prevalence of the FB sign in a large
artery. sample of patients with ICAD and healthy intracranial

Volume 2 Issue 4 (2023) 5 https://doi.org/10.36922/an.1238