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Visualization of the Intimal Flap in Intracranial Arterial Dissection Using High-Resolution 3T MRI
Masahiro Uemura1, Kenshi Terajima1,2,3, Yuji Suzuki2
1Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan.
Background And Purpose:
Presence of an intimal flap is a critical imaging finding in diagnosing intracranial artery dissection (ICAD). Recent reports showed that high-resolution magnetic resonance imaging (MRI) was better at identifying intimal flaps as compared with routine MRI techniques used in clinical settings. However, no current standardized sequence for high-resolution MRI without gadolinium enhancement produces images of satisfactory quality with clinically tolerable scanning times. This study evaluated a nonenhanced high-resolution fast spin echo (HR-FSE) MRI sequence for visualizing intimal flaps in patients with ICAD.
Subjects And Methods:
Three patients with ICAD underwent plain MRI examination using a 2-dimensional T2-weighted FSE imaging sequence optimized for our 3T system (in-plane pixel size, .23 mm × .23 mm; slice thickness 3 mm with no interslice gap), as well as scanning with conventional modalities, including CT angiography, magnetic resonance angiography, and digital subtraction angiography. We assessed whether these imaging methods could visualize an intimal flap and/or double lumen sign in the participants and compared the results between HR-FSE and the other modalities.
Results:
HR-FSE images clearly showed intimal flaps and double lumen signs in all 3 patients, whereas the conventional modalities identified a double lumen sign in only 2 of the 3 patients.
Conclusions:
The present method of optimized HR-FSE imaging with a 3T system improved visualization of intimal flaps and should thus be considered for assessing patients with suspected ICAD that cannot be definitively diagnosed by conventional imaging modalities.
Insights
High-resolution fast spin echo (HR-FSE) MRI effectively visualizes intimal flaps in intracranial artery dissection (ICAD), outperforming conventional methods. This nonenhanced sequence offers improved diagnostic accuracy for ICAD patients.
Area of Science:
- Neuroradiology
- Vascular Imaging
- Magnetic Resonance Imaging
Background:
- Intimal flap presence is key for diagnosing intracranial artery dissection (ICAD).
- High-resolution MRI (HR-MRI) shows promise for intimal flap visualization over routine MRI.
- A standardized, nonenhanced HR-MRI sequence with acceptable scan times is lacking.
Observation:
- A novel nonenhanced high-resolution fast spin echo (HR-FSE) MRI sequence was evaluated in three patients with ICAD.
- Conventional modalities (CT angiography, MR angiography, digital subtraction angiography) were used for comparison.
- The study assessed the visualization of intimal flaps and double lumen signs.
Findings:
- HR-FSE imaging clearly depicted intimal flaps and double lumen signs in all three ICAD patients.
- Conventional imaging methods identified the double lumen sign in only two of the three patients.
- The optimized HR-FSE sequence demonstrated superior visualization of intimal flaps.
Implications:
- Optimized HR-FSE MRI at 3T enhances intimal flap visualization in ICAD.
- This technique should be considered for diagnosing ICAD when conventional imaging is inconclusive.
- Improved nonenhanced imaging may enhance diagnostic capabilities for cerebrovascular diseases.
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