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Published on: November 20, 2015
Spontaneous and Unruptured Chronic Intracranial Artery Dissection : High-resolution Magnetic Resonance Imaging
Seung Chai Jung1, Ho Sung Kim2, Choong-Gon Choi2
1Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, 138-736, Seoul, Songpa-Gu, Republic of Korea. dynamics79@gmail.com.
Insights
High-resolution MRI reveals distinct chronic changes in spontaneous intracranial artery dissection (ICAD). These findings aid in classifying ICAD into categories like normalization, aneurysm, or occlusion.
Area of Science:
- Neuroradiology
- Vascular Imaging
- Neurology
Background:
- Intracranial artery dissection (ICAD) is a significant cause of stroke.
- Chronic stage findings of spontaneous ICAD are less understood.
- High-resolution magnetic resonance imaging (HR-MRI) offers detailed visualization of vessel walls.
Purpose of the Study:
- To present high-resolution magnetic resonance imaging (HR-MRI) findings in patients with chronic stage spontaneous and unruptured intracranial artery dissection (ICAD).
- To characterize the morphological features of chronic ICAD using HR-MRI.
Main Methods:
- Retrospective enrollment of 29 patients with chronic stage spontaneous and unruptured ICAD (vertebral, posterior inferior cerebellar, middle cerebral arteries).
- HR-MRI performed >2 months after symptom onset.
- HR-MRI findings evaluated against luminal angiography, focusing on lumen wall morphology (thickening, enhancement, residual dissection).
Main Results:
- HR-MRI findings classified into: complete normalization (n=6), complete normalization with minimal wall changes (n=8), incomplete normalization (n=4), dissecting aneurysm (n=8), and occlusion (n=3).
- Morphological features included lumen wall thickening, contrast enhancement, dilatation, stenosis, fusiform aneurysm, and reduced arterial diameter.
Conclusions:
- HR-MRI effectively demonstrates distinguishing morphological features of chronic spontaneous and unruptured ICAD.
- The identified HR-MRI patterns (normalization, aneurysm, occlusion) are crucial for understanding the disease progression.
Purpose:
The aim of this article is to present high-resolution magnetic resonance imaging (HR-MRI) findings of chronic stage spontaneous and unruptured intracranial artery dissection (ICAD).
Material And Methods:
From March 2012 to April 2016 a total of 29 patients (15 male and14 female, age range 37-68 years) with chronic stage spontaneous and unruptured ICAD (vertebral artery 27, posterior inferior cerebellar artery 1 and middle cerebral artery 1) were retrospectively enrolled. Patients underwent HR-MRI more than 2 months (median interval 564 days, range 69-391 days) after symptom onset and were diagnosed at symptom onset or at the first imaging acquisition, which included luminal angiography and/or HR-MRI with clinical information. The HR-MRI findings were evaluated against those of luminal angiography on the basis of the lumen wall morphology, including thickening, contrast enhancement and residual dissection.
Results:
The HR-MRI findings were classified into complete normalization (normal lumen and wall with or without mild enhancement, n = 6), complete normalization with minimal wall changes (focal wall thickening with enhancement but normal luminal angiography, n = 8), incomplete normalization (focal wall thickening with enhancement with dilatation and stenosis on luminal angiography, n = 4), dissecting aneurysm (fusiform aneurysm with residual dissection findings, n = 8) and occlusion (small outer arterial diameter with diffuse contrast enhancement, n = 3).
Conclusion:
The use of HR-MRI can demonstrate the distinguishing morphological features of chronic stage of spontaneous and unruptured ICAD as complete normalization, complete normalization with minimal wall changes, incomplete normalization, dissecting aneurysm and occlusion.
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