AccScience Publishing / AN / Online First / DOI: 10.36922/an.1238
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ORIGINAL RESEARCH ARTICLE

Fried-Breadstick sign: A novel marker for healthy vasculature in magnetic resonance angiography

Yannan Yu1,2 ,  Yu-Yuan Xu1 ,  Xue Man1 ,  Ming-Li Li3 ,  Bo Hou3 ,  Shan Gao1 ,  Feng Feng3 ,  David S Liebeskind2 ,  Wei-Hai Xu1*
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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
Advanced Neurology 2023, 2(4), 1238 https://doi.org/10.36922/an.1238
Submitted: 4 July 2023 | Accepted: 28 November 2023 | Published: 21 December 2023
© 2023 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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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 with suspected middle cerebral artery (MCA) atherosclerosis, covering the period from January 2007 to August 2015. We conducted a comparative analysis of ICA stenosis, MCA atherosclerosis and stenosis degree, and the terminal ICA bifurcation angle between ICA-MCAs with and without the Fried-Breadstick sign, involving a total of 1,005 ICA-MCAs from 553 patients. The Fried-Breadstick sign exhibited a higher prevalence in non-to-mild stenotic ICAs (57.5% vs. 9.8% in severely stenotic ICA, P < 0.001) and plaque-free MCAs (53.2% vs. 26.6% in MCAs with plaque, P < 0.001). Factors independently associated with the presence of the Fried-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 stenosis, moderate stenosis: OR: 0.39, 95% CI: 0.28 – 0.54, severe stenosis: OR: 0.10, 95% CI: 0.06 – 0.17), and terminal ICA bifurcation angle (OR: 0.86/10° increase, 95% CI: 0.79 – 0.93). In atherosclerotic MCAs without luminal narrowing, the Fried-Breadstick sign was also less frequently observed than in plaque-free MCAs (34.6% vs. 53.2%, P = 0.012). In conclusion, the presence of the Fried-Breadstick sign is associated with healthier ICA-MCAs devoid of stenosis or plaque. The Fried-Breadstick sign may signify healthy ICA-MCA hemodynamics, serving as a potential screening tool for intracranial atherosclerosis without incurring additional cost or risk.

Keywords
Intracranial atherosclerosis
Middle cerebral artery
Hemodynamics
Vessel wall magnetic resonance imaging
Magnetic resonance angiography
Funding
National Science Fund for Distinguished Young Scholars
National Natural Science Foundation of China
National Key Technologies R&D Program of China
Conflict of interest
The authors declare no conflict of interest.
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Advanced Neurology, Electronic ISSN: 2810-9619 Print ISSN: 3060-8589, Published by AccScience Publishing
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