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Published on: July 28, 2018
Age determination of vessel wall hematoma in spontaneous cervical artery dissection: a multi-sequence 3T
Maximilian Habs1, Thomas Pfefferkorn, Clemens C Cyran
1Dept, of Clinical Radiology, University of Munich, Grosshadern Campus, Munich, Germany.
Insights
Cardiovascular magnetic resonance (CMR) can determine the age of vessel wall hematoma (VWH) in spontaneous cervical artery dissection (sCAD). Findings suggest carotid hematoma timing differs from cerebral hematoma timing.
Area of Science:
- Vascular Imaging
- Neurology
- Radiology
Background:
- Established classifications exist for carotid plaque and cerebral hemorrhages to estimate hematoma age via MRI signal intensities.
- The study investigates the utility of cardiovascular magnetic resonance (CMR) for dating vessel wall hematomas (VWH) in spontaneous cervical artery dissection (sCAD).
Purpose of the Study:
- To systematically evaluate CMR's effectiveness in determining the age of VWH in sCAD patients.
- To compare the signal intensity evolution of VWH in sCAD with existing classifications for cerebral and carotid hemorrhages.
Main Methods:
- 35 sCAD patients underwent multi-sequence 3T CMR, including T1w, T2w, and TOF sequences.
- VWH were categorized into five stages (hyperacute to chronic) based on T1w and T2w signal intensities.
- Patient age of sCAD was defined as the time from symptom onset to CMR scan.
Main Results:
- Mean sCAD ages were 2.0, 5.8, 15.7, and 58.7 days for acute, early subacute, late subacute, and chronic VWH, respectively (p < 0.001).
- Moderate agreement (Cohen's kappa = 0.43) was found between CMR VWH classification and cerebral hemorrhage timing schemes.
- Strong agreement (Cohen's kappa = 0.74) was observed between CMR VWH classification and carotid intraplaque hematoma timing schemes.
Conclusions:
- VWH signal intensities in sCAD change over time, enabling age determination using multi-sequence CMR.
- CMR is a valuable tool for assessing the age of arterial dissection.
- The temporal progression of carotid hematomas appears distinct from that of cerebral hematomas.
Background:
Previously proposed classifications for carotid plaque and cerebral parenchymal hemorrhages are used to estimate the age of hematoma according to its signal intensities on T1w and T2w MR images. Using these classifications, we systematically investigated the value of cardiovascular magnetic resonance (CMR) in determining the age of vessel wall hematoma (VWH) in patients with spontaneous cervical artery dissection (sCAD).
Methods:
35 consecutive patients (mean age 43.6 ± 9.8 years) with sCAD received a cervical multi-sequence 3T CMR with fat-saturated black-blood T1w-, T2w- and TOF images. Age of sCAD was defined as time between onset of symptoms (stroke, TIA or Horner's syndrome) and the CMR scan. VWH were categorized into hyperacute, acute, early subacute, late subacute and chronic based on their signal intensities on T1w- and T2w images.
Results:
The mean age of sCAD was 2.0, 5.8, 15.7 and 58.7 days in patients with acute, early subacute, late subacute and chronic VWH as classified by CMR (p < 0.001 for trend). Agreement was moderate between VWH types in our study and the previously proposed time scheme of signal evolution for cerebral hemorrhage, Cohen's kappa 0.43 (p < 0.001). There was a strong agreement of CMR VWH classification compared to the time scheme which was proposed for carotid intraplaque hematomas with Cohen's kappa of 0.74 (p < 0.001).
Conclusions:
Signal intensities of VWH in sCAD vary over time and multi-sequence CMR can help to determine the age of an arterial dissection. Furthermore, findings of this study suggest that the time course of carotid hematomas differs from that of cerebral hematomas.
