Spontaneous intracranial vertebral artery dissection with acute ischemic stroke: High-resolution magnetic resonance imaging findings

Abstract

Background Acute ischemic stroke (AIS) more frequently develops in patients with intracranial vertebral artery dissection (VAD) than extracranial VAD, and is associated with possible poor clinical outcomes. The aim of this study is to compare high-resolution magnetic resonance imaging (HR-MRI) findings and clinical features of VAD with and without AIS. Methods Twenty-nine lesions from 27 patients (15 male and 12 female patients; age range = 28-73 years) who underwent diffusion MRI and 3T HR-MRI within seven days were included. We classified VAD according to the presence of AIS lesions on diffusion MRI. Clinical features and HR-MRI findings (angiographic patterns, presence of double lumen sign, dissecting flap, posterior inferior cerebellar artery involvement, remodeling index, length of affected vessels, T1-signal intensity, area of intramural hematoma, and grades and patterns of vessel wall enhancement) were evaluated. Results Thirteen VADs with AIS and 16 without AIS were included. There were no significant differences in the clinical parameters (sex, age, risk factors, symptoms). More VADs with AIS presented as a steno-occlusive pattern than VADs without AIS. More VADs without AIS presented with aneurysmal dilation, larger mean remodeling index and longer mean length than VADs with AIS. Presence of intramural hematoma, T1-iso-signal intensity of intramural hematoma and contrast enhancement were significantly more common in VADs with AIS than without AIS. Conclusions Our study showed some differences in HR-MRI comparing intracranial VAD patients with and without AIS. Differing findings may facilitate a better understanding of intracranial VAD and risk assessment of AIS in these patients.

High-Resolution Magnetic Resonance Imaging (HR-MRI) Imaging Characteristics of Vertebral Artery Dissection with Negative MR Routine Scan and Hypoperfusion in Arterial Spin Labeling

“…Based on this, researchers recommend the application of arterial wall combined with luminal imaging technology to diagnose arterial dissection, and have pointed out that the diagnosis of dissection disease requires evidence of intramural hematoma or characteristics of dynamic imaging changes [ 4 , 5 ]. As a multi-parameter imaging sequence with ideal tissue contrast and spatial resolution, high-resolution magnetic resonance imaging (HR-MRI) is not only able to obtain luminal morphology information, but more importantly, the characteristic intramural hematoma, intimal flap, and double-lumen sign caused by arterial dissection can be directly visualized through wall imaging [ 6 , 7 ]. Therefore, HR-MRI is recommended as the first choice for diagnosing arterial dissection [ 4 , 8 ].…”

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

“…Eight of the included articles were retrospective in design ( 4 , 7 , 8 , 11 , 13 – 15 , 29 ), whereas three studies were prospective ( 9 , 10 , 12 ). The reference standard for diagnosing AD was a combination of clinical, radiological, and luminal angiography diagnoses in three studies ( 12 , 14 , 29 ) and of clinical, radiological, luminal angiography, and follow-up MRI in eight studies ( 4 , 7 – 11 , 13 , 15 ). Two of these studies specifically used the spontaneous AD criteria for clinical diagnosis ( 8 , 15 ), and two used the Strategies Against Stroke Study for Young Adults in Japan criteria ( 11 , 14 ).…”

High-resolution MRI of intracranial large artery diseases: how to use it in clinical practice?

“…For a long stenosis, intracranial atherosclerosis may display concentric features on several image slices, but it always has at least one slice with eccentric lesion (figure 5). Different diagnosis may be required in patients with intracranial artery dissection 10. However, vessel wall haematoma at non-atherosclerosis sites is usually easier to be identified on HRMRI, as compared with other vessel imaging such as CT angiography and magnetic resonance angiography.…”