Chinese specialist consensus on imaging diagnosis of intracranial arterial dissection

Abstract

Intracranial arterial dissection is an important cause of stroke in young and middle-aged adults, but there are no domestic or globally-accepted criteria for the diagnosis and classification of intracranial arterial dissections. The evidence base for the benefits of diagnostic and interventional angiography techniques is lacking, and the imaging features of intracranial arterial dissections are not yet universally recognized or understood by clinicians. These issues influence the diagnosis and treatment of intracranial arterial dissection. Therefore, a consensus conference was convened by Neurointerventional Expert Committee of Chinese Congress of Neurological Surgeons, Chinese Interventional Neuroradiology Society of Chinese Stroke Association and Young Physicians Committee of Chinese Congress of Neurological Surgeons. The aim of this document is to report an expert consensus on the imaging diagnosis of intracranial arterial dissection. The participating clinical experts utilized their judgment and experience. Every effort was made to achieve consensus among the committee members. The expert consensus was intended to provide guidance, but they are not to be considered prescriptive for any individual patient and cannot replace the judgment of a clinician.

Vertebral Artery Stenting for Acute Multiple Cerebral Infarctions Caused by Vertebral Artery Dissection After Massage: A Case Report

“…Typical features of VAD on DSA include eccentric stenosis with external duct dilatation, beaded or segmental stenosis, intramural hematoma, double-lumen sign, formation of intimal flaps and a dissecting aneurysm. Among them, the double-lumen sign and intimal flaps are directly diagnostic of arterial dissection [11] . Irregular lumen stenosis or occlusion, thin line sign, rat tail sign, and dissecting aneurysm in DSA have also been reported as diagnostic signs of arterial dissection [12] .…”

Postpartum cerebral arterial dissections

“…At present, there are no unified imaging diagnosis standards, and it is recommended to use a variety of imaging methods to evaluate the signs of arterial wall and lumen to make clear the diagnosis of cerebral arterial dissection. The diagnosis was made if any one of the following signs was present [55][56][57] : double lumen sign, intimal flap sign, and intramural hematoma on CTA and/or MRA, or reverse flow signal, double lumen change and/or floating intima on ultrasound. The high resolution MRI tube wall imaging technology has been reported to have a high diagnostic efficiency for cerebral arterial dissections and can be used directly to display the characteristics of vascular wall while being non-irradiating and noninvasive.…”