MR diagnosis of vertebral artery dissection: value of 3D time-of-flight and true fast imaging with steady-state precession fusion imaging

Abstract

ObjectivesWe hypothesized that 3D time-of-flight (TOF) and true fast imaging with steady-state precession (true-FISP) fusion imaging could provide more information regarding the arterial vessel wall. The purpose of this study was to compare the accuracy of lesion detection and the diagnostic confidence of VAD between TOF images alone and fused TOF and true-FISP images.MethodsFifty patients were studied: 17 had VAD and 33 had vertebral artery hypoplasia. Fusion images of the vertebral artery were reconstructed using a workstation. A receiver-operating characteristic (ROC) analysis was conducted with a continuous rating scale from 1 to 100 to compare observer performance in VAD detection. Five radiologists participated in the observer performance test, and their performances with TOF images were compared with those using fused images.ResultThe observers found that the mean areas under the best-fit ROC curve for TOF images alone and fused TOF images were 0.66 ± 0.05 and 0.93 ± 0.04, which were significantly different (P < 0.01).ConclusionThe fusion images provided more information regarding the arterial vessel wall. Fused images aided distinction between vertebral artery dissection versus vertebral artery hypoplasia.Key Points• New MR techniques can help to differentiate flowing blood from static blood products.• Fused TOF and true-FISP images differentiate the lumen and the arterial wall, improving diagnostic performance.• Fused images may be superior to time-of-flight MR angiography alone.

Vertebral artery hypoplasia and vertebral artery dissection

“…30 We included only incident cases to minimize prevalence or incidence bias and used a matched design to minimize confounding bias. 19,[33][34][35][36][37] Fourth, the study population consisted of ethnically Chinese patients from a single center; the observed frequency of VAH may not be globally representative and the generalizability of our results is limited. 30 Similarly, the determination of exposure status by imaging examination, rather than patients' selfreports or other forms of subjective evaluation, avoided information bias.…”

Image Findings of Acute to Subacute Craniocervical Arterial Dissection on Magnetic Resonance Vessel Wall Imaging: A Systematic Review and Proportion Meta-Analysis

“…No additional articles were identified after searching their bibliographies. After full-text reviews of these 19 articles, eight were excluded because they contained insufficient information in terms of the proportion of image findings of acute to subacute craniocervical AD on MR-VWI ( 2 , 5 , 6 , 23 – 27 ) and one because of suspected population overlap ( 28 ). Finally, 11 articles were included in the final analysis ( 4 , 7 – 15 , 29 ).…”

Bilateral vertebral artery dissection complicated by posterior circulation stroke in a young man

“…[ 13 ] DSA remains the gold standard for VAD diagnosis; however, MRA, computed tomography angiography, and DSA only clearly visualize the vessel lumen. [ 14 ] Meanwhile, as in the current patient, hematoma of the arterial wall can be visualized on T1-weighted images with fat suppression as hyperintensity of the vessel wall, which is a frequently neglected hallmark for artery dissection. High-resolution-MRI can show not only arterial lumen abnormalities but also intramural and peri-arterial pathologies, [ 15 ] and was equally applied in the current patient.…”