Background Internal carotid artery dissection (ICAD) is the major cause of ischemic stroke in young to middle-aged people. Recognition of predisposing factors may facilitate in early individual risk prediction and expand treatment. Purpose To evaluate the association between a carotid web and dissection in patients with ICAD using vessel wall magnetic resonance imaging (VW-MRI). Material and Methods A retrospective study was conducted of 223 patients who underwent VW-MRI. Of these patients, 58 patients with craniocervical artery dissection (CCAD) (33 ICAD and 25 vertebrobasilar artery dissection [VBAD]) were included. The control group (n = 165) consisted of patients without arterial dissection who had undergone VW-MRI . The presence of a carotid web in the posterior aspect of carotid bulb was recorded. The distance between the carotid web and start of dissection in ICA was recorded. Results The presence of a carotid web showed a significant difference between the ICAD, VBAD, and control groups (19 [57.6%] vs. 5 [20%] vs. 36 [21.8%], respectively; P < 0.001). In multi-nominal analysis, the presence of a carotid web showed a significant difference between the ICAD and VBAD groups and the ICAD and control groups ( P < 0.05), with odds ratios of 5.41 (95% confidence interval [CI]=1.634–17.973) and 4.81 (95% CI=2.176–10.651), respectively. Out of 19 ICAD patients with carotid web, 16 had occurrence of dissection in the C1 segment of the ICA with a mean distance of 1.91 ± 1.71 cm from the carotid web. Conclusion Presence of a carotid web was more frequent in patients with ICAD. The carotid web may be one of the predisposing factors for development of dissection in patients with ICAD.

Objective. The objective of this study was to assess the performance of combining MRI-based texture analysis with machine learning for differentiating sepsis-associated encephalopathy (SAE) from sepsis alone. Method. Sixty-six MRI-T1WI images of an SAE patient and 125 images of patients with sepsis alone were collected. Frontal lobe, brain stem, hippocampus, and amygdala were selected as regions of interest (ROIs). 279 texture features of each ROI were obtained using MaZda software. After the dimension reduction, 30 highly discriminative features of each ROI were adopted to differentiate SAE from sepsis alone using the CatBoost model. Results. The classification models of frontal, brain stem, hippocampus, and amygdala were constructed. The classification accuracy was above 0.83, and the area under the curve (AUC) exceeded 0.90 in the validation set. Conclusion. The texture features differed between SAE patients and patients with sepsis alone in different anatomical locations, suggesting that MRI-based texture analysis with machine learning might be helpful in differentiating SAE from sepsis alone.

Objective: To study the ischemic stroke risk factors in spontaneous internal carotid artery dissection (ICAD) patients via analyzing the dissection features and primary collateral circulation using vessel wall-MRI and MRA. Methods: ICAD patients who had undergone VW-MRI were included in this study. A total of 36 patients were included and divided into ICAD stroke (N = 23) and non-stroke (N = 13) group. Dissection imaging features (intramural hematoma (IMH), length of IMH, intimal flap, double lumen, intraluminal thrombus, degree of stenosis) and primary collateral status were analyzed. The primary collateral score (0–4) was evaluated based on presence of anterior communicating and ipsilateral anterior cerebral artery A1 segment (0–2) and ipsilateral posterior communicating artery (0–2). Results: There were no significant differences in dissection imaging features such as presence of double lumen, intimal flap, IMH, length of IMH and intraluminal thrombus between the two groups. Degree of stenosis and primary collateral score showed significant differences between the two groups. Conclusions: Both the poor primary collateral circulation and severe stenosis may play important role in occurrence of ischemic stroke for spontaneous ICAD patients and good primary collateral circulation can help to reduce the incidence of infarction. Advances in knowledge: ICAD is one of the major causes of ischemic stroke. Early evaluation of the status of the Circle of Willis in ICAD patients by MRI may help to make treatment strategies and improve clinical outcome.