Visualization of the Intimal Flap in Intracranial Arterial Dissection Using High‐Resolution 3T MRI

Uemura, Masahiro; Terajima, Kenshi; Suzuki, Yuji; Watanabe, Masaki; Akaiwa, Yasuhisa; Katada, Shinichi; Okamoto, Kouichirou; Nishizawa, Masatoyo; Igarashi, Hironaka; Nakada, Tsutomu

doi:10.1111/jon.12380

Cited by 5 publications

(2 citation statements)

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“…The intimal ap was de ned as a linear partition that passed through the ow cavity and extended to the side wall on the continuous cross-section of each MRI sequence [10] (yellow arrows in Figures 3 and 5). A double lumen was de ned when the blood ow was detected in both the false lumen and the true lumen [11] (red arrows in Figures 4 and 5). Aneurysmal protrusion, including dissecting aneurysm and pseudoaneurysms, was de ned as an aneurysm with a vessel diameter exceeding the diameter of the normal distal artery by ≥ 1.5-fold [12] (Figure 1, green arrows in Figure 5, and Figure 6).…”

Section: Image Analysismentioning

confidence: 99%

Imaging investigation of cervicocranial artery dissection by using high resolution magnetic resonance VWI and MRA : qualitative and quantitative analysis at different stages

Zhou

Lan

et al. 2022

Preprint

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Background To explore the value of magnetic resonance angiography(MRA) and high resolution magnetic resonance vessel wall imaging(HRMR-VWI) in cervicocranial artery dissection(CCAD) diagnosis and disease staging.On the basis of qualitative evaluation,this study also extract the dynamic changes in vessel wall in different vessel segments to identify imaging indicators for the quantitative evaluation of CCAD. Methods We retrospectively enrolled 33 patients with CCAD（37 branches）with conventional MRA and HRMR-VWI examinations.Two radiologists independently analyzed imaging features of vessel wall and lumen in the different stages,and the typical sign detection of artery dissection were compared between MRA and HRMR-VWI.Then the parameters of vessel wall was quantitatively evaluated by Vesselmass.Results HRMR-VWI revealed typical sign detection of artery dissection in all patients in the acute and subacute stage.Among them,the intimal flap/double lumen sign ditection were more common than the MRA,there was significant difference(P=0.01).MRA revealed typical sign detection of artery dissection in more than half the patients,and the detection was no significant difference at the chronic stage between MRA and HRMR-VWI(P=1.000/1.000/0.761).In the acute and subacute stage, the typical sign detection of artery dissection revealed by HR-MRI was higher than the observations in the chronic stage(P=0.028),while there was no significant difference by MRA(P=0.682/1.000). The relative signal intensity of IMH and wall enhancement, wall thickness index were gradually decreased from the acute stage to the chronic stage;Significant differences were found between the recovered group of chronic stage and the acute stage(P＜0.05),but it is no significant difference between the recovered group of chronic stage and the acute stage(p=1.000、0.061).Conclusions As the only noninvasive imaging technology, HRMR-VWI displays the structure of the vessel wall in vivo, showing not only excellent performance in the early diagnosis of CCAD, but also describing the dynamic changes in the qualitative and quantitative characteristics of vessel wall. It also helps to guide the disease course, staging, prognosis, and treatment of CCAD.Although the diagnostic efficacy of MRA was not as good as HRMR-VWI, it should be the first choice of method for routine examination in evaluating CCAD, especially at the chronic stage of CCAD.

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Section: Image Analysismentioning

confidence: 99%

Imaging investigation of cervicocranial artery dissection by using high resolution magnetic resonance VWI and MRA : qualitative and quantitative analysis at different stages

Zhou

Lan

et al. 2022

Preprint

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“…ICAD is diagnosed based on specific imaging findings, such as the presence of an intimal flap or a double lumen sign [9]. It may also be possible to use DSA, although this invasive procedure is not practical for all patients, and HR-MRI requires additional cost and effort for a neuroradiologist to manually target the potential lesion using existing conventional MRI data, which makes it difficult to use for patients with suspected ICAD [10].…”

Section: Using the Region Of Interest Frommentioning

confidence: 99%

Using the Region of Interest from Time-of-Flight Magnetic Resonance Angiography to Differentiate Between Intracranial Arterial Dissection and True Atherosclerotic Stenosis

et al. 2019

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Background: Noncontrast three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) is commonly used to examine intracranial arterial stenosis, although it can be difficult to identify the etiology of the stenosis. Our aim was to determine the effectiveness of 3D TOF MRA in differentiating an intracranial arterial dissection from atherosclerosis. Methods: During 2015–2017, 356 patients had confirmed intracranial arterial stenosis based on high resolution-magnetic resonance imaging. This study ultimately included 51 patients with severe focal stenosis that was caused by dissection and atherosclerosis. We compared the dissection group with the atherosclerotic narrowing group by measuring the region-of-interest (ROI) values 3 mm proximal and 3 mm distal from sites of severe focal stenosis. Results: A significant difference was observed between the median ROI difference values in the dissection group (n = 18) and the atherosclerosis group (n = 33; 35.6 [20.9–78.4] vs. 165.5 [99.8–328.5]; p < 0.001). A receiver operating characteristic curve was prepared to distinguish between dissection and atherosclerosis using the ROI difference values. The area under the curve was 0.919 (sensitivity 75.8%, specificity 94.4%). The optimal cutoff value for using ROI to distinguish between dissection and atherosclerosis was found to be 99.0 based on the Youden’s index. Conclusion: The ROI difference value from 3D TOF MRA could help distinguish between dissection and atherosclerosis. If the ROI difference value from 3D TOF MRA is small (< 99.0), detailed testing should be performed to identify dissection.

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MR Angiography of Extracranial Carotid Disease

Peret

Romero-Sánchez

Dabiri

et al. 2023

Magnetic Resonance Imaging Clinics of North America

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Visualization of the Intimal Flap in Intracranial Arterial Dissection Using High‐Resolution 3T MRI

Abstract: BACKGROUND AND PURPOSE: Presence of an intimal flap is a critical imaging finding in diagnosing intracranial artery dissection (ICAD).

Cited by 5 publications

References 5 publications

Imaging investigation of cervicocranial artery dissection by using high resolution magnetic resonance VWI and MRA : qualitative and quantitative analysis at different stages

Imaging investigation of cervicocranial artery dissection by using high resolution magnetic resonance VWI and MRA : qualitative and quantitative analysis at different stages

Using the Region of Interest from Time-of-Flight Magnetic Resonance Angiography to Differentiate Between Intracranial Arterial Dissection and True Atherosclerotic Stenosis

MR Angiography of Extracranial Carotid Disease

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