Standard Diffusion-Weighted Imaging in the Brain Can Detect Cervical Internal Carotid Artery Dissections.

Area of Science:

• Neurology
• Radiology
• Vascular Imaging

Background:

• Cervical artery dissection, particularly internal carotid artery (ICA) dissection, is a common cause of stroke in younger adults.
• Early identification of mural hematoma is crucial for managing suspected cervical artery dissections.
• Diffusion-weighted imaging (DWI) is a standard MRI sequence routinely used in brain imaging.

Purpose of the Study:

• To evaluate the diagnostic capacity of standard brain DWI sequences in detecting mural hematomas associated with cervical ICA dissections.
• To assess the effectiveness of routine DWI in identifying dissections when clinically suspected.

Main Methods:

• Retrospective analysis of 110 patients under 55 with acute neurological symptoms, headache, or neck pain.
• Inclusion of patients investigated with at least a 3T brain DWI sequence.
• Independent assessment of DWI sequences by senior and junior radiologists for subpetrosal ICA hyperintensities indicative of mural hematoma.

Main Results:

• A senior radiologist detected mural hematomas in 43/50 patients with confirmed ICA dissection (86% sensitivity, 100% specificity).
• A junior radiologist identified mural hematomas in 45/50 patients with confirmed ICA dissection (90% sensitivity, 100% specificity).
• No hyperintensities were found in patients without dissection.

Conclusions:

• Standard brain DWI sequences are highly sensitive and specific for detecting cervical ICA dissections in the acute phase.
• Routine DWI imaging can reliably identify mural hematomas, supporting the diagnosis of ICA dissection.
• This study highlights the utility of DWI in the prompt evaluation of suspected cervical artery dissections.