Identification of high risk clinical and imaging features for intracranial artery dissection using high-resolution cardiovascular magnetic resonance

Abstract

Background Intracranial artery dissection (IAD) often causes headache and cerebral vascular ischemic events. The imaging characteristics of IAD remain unclear. This study aims to characterize the appearance of culprit and non-culprit IAD using high-resolution cardiovascular magnetic resonance imaging (hrCMR) and quantify the incremental value of hrCMR in identifying higher risk lesions. Methods Imaging data from patients who underwent intervention examination or treatment using digital subtraction angiography (DSA) and hrCMR using a 3 T CMR system within 30 days after the onset of neurological symptoms were collected. The CMR protocol included diffusion-weighted imaging (DWI), black blood T1-, T2- and contrast-enhanced T1-weighted sequences. Lesions were classified as culprit and non-culprit according to imaging findings and patient clinical presentations. Univariate and multivariate analyses were performed to assess the difference between culprit and non-culprit lesions and complementary value of hrCMR in identifying higher risk lesions. Results In total, 75 patients were included in this study. According to the morphology, lesions could be classified into five types: Type I, classical dissection (n = 50); Type II, fusiform aneurysm (n = 1); Type III, long dissected aneurysm (n = 3); Type IV, dolichoectatic dissecting aneurysm (n = 9) and Type V, saccular aneurysm (n = 12). Regression analyses showed that age and hypertension were both associated with culprit lesions (age: OR, 0.83; 95% CI 0.75–0.92; p < 0.001 and hypertension: OR, 66.62; 95% CI 5.91–751.11; p = 0.001). Hematoma identified by hrCMR was significantly associated with culprit lesions (OR, 16.80; 95% CI 1.01–280.81; p = 0.037). Moreover, 17 cases (16 lesions were judged to be culprit) were diagnosed as IAD but not visible in DSA and 15 were Type I lesion. Conclusion hrCMR is helpful in visualizing and characterizing IAD. It provides a significant complementary value over DSA for the diagnosis of IAD.

Assessment of Morphological Features and Imaging Characteristics of Patients with Intracranial Artery Dissection: A High-Resolution MRI Study

“…Since an ischemic event caused by a culprit dissection might seriously affect the prognosis of an IAD patient, finding predictive factors is of great significance. It was suggested in a previous study that hypertension was a key factor for vertebral artery dissection [35]. In accordance with previous studies, a remarkable difference was found here in the percentage of patients with hypertension, together with double lumen and intimal flap between culprit and non-culprit.…”

Uncommon Female-Predominant Etiologies of Cryptogenic Stroke

“…The smaller diameters of these arteries limit the ability of routine vascular imaging examinations to detect characteristic imaging features of dissection, including true and false lumen and intimal flap; the dissection tends to be missed or misdiagnosed as aneurysm, vasculitis, or fibromuscular dysplasia, etc. (32,33).…”

Case report: Acute ischemic stroke caused by intracranial artery dissection in a patient with skull fractures

“…It could demonstrate the distinguishing morphological features of the chronic stage of spontaneous and unruptured IAD as complete normalization, complete normalization with minimal wall changes, incomplete normalization, dissecting aneurysm, and occlusion ( 13 ). It provided a significant complementary value over DSA for the diagnosis of IAD ( 14 ). In predicting IAD changes, quantitative analysis of contrast enhancement on magnetic resonance vessel wall imaging (MR–VWI) could predict the instability of unruptured IAD ( 15 ).…”