3D T1-weighted black blood sequence at 3.0 Tesla for the diagnosis of cervical artery dissection
Yun Luo1, Zhen-Ni Guo1, Peng-Peng Niu1
1Stroke Center, Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.
Insights
Three-dimensional T1 VISTA imaging is valuable for diagnosing cervical artery dissection (CAD). While highly sensitive and specific, it may not definitively diagnose dissection in all cases of total artery occlusion.
Area of Science:
- Radiology
- Neurology
- Vascular Imaging
Background:
- Cervical artery dissection (CAD) is a significant cause of stroke in younger individuals.
- Accurate and timely diagnosis of CAD is crucial for appropriate management and prevention of complications.
Purpose of the Study:
- To evaluate the diagnostic utility of three-dimensional (3D) T1 volumetric isotropic turbo spin echo acquisition (VISTA) for cervical artery dissection (CAD).
Main Methods:
- Prospective study of 46 patients with suspected CAD within one month of symptom onset.
- Diagnosis of dissection using T1 VISTA based on intramural high-signal, intimal flap, double lumen, and aneurysmal dilation.
- Final diagnosis confirmed by clinical history, physical examination, and all imaging modalities.
Main Results:
- T1 VISTA diagnosed dissection in 20 out of 21 confirmed CAD cases (95.2% sensitivity, 100% specificity).
- Excellent inter-rater agreement (k=0.91) for T1 VISTA diagnosis.
- T1 VISTA provided definitive conclusions in patients without acute artery occlusion but faced challenges in cases with total occlusion.
Conclusions:
- 3D T1 VISTA at 3.0 Tesla is effective for diagnosing acute CAD.
- Distinguishing intramural hematoma from intraluminal thrombus in total occlusions may require additional imaging techniques.
- Further research is needed to optimize VISTA techniques or incorporate follow-up/contrast-enhanced imaging.
Objective:
We aimed to investigate the value of three-dimensional (3D) T1 volumetric isotropic turbo spin echo acquisition (VISTA) in the diagnosis of cervical artery dissection (CAD).
Methods:
We prospectively included patients who were suspected as having a CAD within 1 month of onset. For T1 VISTA, the diagnosis of the dissection was based on the presence of intramural high-signal, intimal flap, double lumen and aneurysmal dilation. The final diagnosis of dissection was based on the clinical history, physical examination, and all of the imaging tests.
Results:
A total of 46 patients were included in this study. The final diagnosis of CAD was made for 21 patients. Diagnosis of dissection was made for 20 of the 21 patients after assessing T1 VISTA. A definitive diagnosis of dissection was not made for 5 patients (including 3 patients with digital subtraction angiography) before the T1 VISTA examination. The sensitivity and specificity for T1 VISTA were 95.2% (95% CI, 76.2% to 99.9%) and 100% (95% CI, 86.3% to 100%), respectively. The agreement between the two researchers for T1 VISTA for diagnosis of CAD was very good (k=0.91). For patients without acute artery occlusion, all of them had a definite conclusion with or without dissection by T1 VISTA (n=29). However, for 17 patients with acute artery occlusion, the possibility of dissection could not be excluded for 6 of them by T1 VISTA (p=0.001).
Conclusions:
3D T1 VISTA at 3.0 Tesla was useful in the diagnosis of acute CAD. However, for some patients with total occlusion of the artery without typical imaging features of dissection, the unequivocal distinction between intramural haematoma and intraluminal thrombus may be not adequate by T1 VISTA alone. Future studies should investigate whether a follow-up scan, a contrast-enhanced imaging or an optimal VISTA technique could be useful.
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