Identification of high risk clinical and imaging features for intracranial artery dissection using high-resolution
Insights
High-resolution cardiovascular magnetic resonance imaging (hrCMR) aids in diagnosing intracranial artery dissection (IAD). hrCMR offers superior insights compared to digital subtraction angiography (DSA) for identifying high-risk lesions.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Imaging
Background:
- Intracranial artery dissection (IAD) is a significant cause of stroke and neurological deficits.
- Current imaging modalities have limitations in fully characterizing IAD lesions.
- Understanding IAD imaging features is crucial for risk stratification and treatment.
Purpose of the Study:
- To characterize the imaging appearance of culprit and non-culprit IAD lesions.
- To evaluate the incremental value of high-resolution cardiovascular magnetic resonance imaging (hrCMR) in identifying higher-risk IAD.
- To compare hrCMR findings with digital subtraction angiography (DSA).
Main Methods:
- Retrospective analysis of 75 patients with suspected IAD.
- Inclusion of patients who underwent both DSA and 3T hrCMR within 30 days of symptom onset.
- Utilized DWI, black blood T1-, T2-, and contrast-enhanced T1-weighted sequences for hrCMR.
- Classified lesions as culprit or non-culprit based on imaging and clinical presentation.
- Performed univariate and multivariate regression analyses.
Main Results:
- Five lesion morphologies were identified: classical dissection, fusiform aneurysm, long dissected aneurysm, dolichoectatic dissecting aneurysm, and saccular aneurysm.
- Age and hypertension were associated with culprit lesions.
- Hematoma, visualized by hrCMR, significantly correlated with culprit lesions (OR, 16.80; P=0.037).
- hrCMR identified 17 IAD cases not visible on DSA, including 15 Type I lesions.
Conclusions:
- hrCMR is effective in visualizing and characterizing intracranial artery dissections.
- hrCMR provides significant complementary diagnostic value beyond DSA for IAD.
- This advanced imaging technique aids in identifying higher-risk lesions and improving diagnostic accuracy.
Background:
Intracranial artery dissection (IAD) often causes headache and cerebral vascular ischemic events. The imaging characteristics of IAD remain unclear. This study aims to characterize the appearance of culprit and non-culprit IAD using high-resolution cardiovascular magnetic resonance imaging (hrCMR) and quantify the incremental value of hrCMR in identifying higher risk lesions.
Methods:
Imaging data from patients who underwent intervention examination or treatment using digital subtraction angiography (DSA) and hrCMR using a 3 T CMR system within 30 days after the onset of neurological symptoms were collected. The CMR protocol included diffusion-weighted imaging (DWI), black blood T1-, T2- and contrast-enhanced T1-weighted sequences. Lesions were classified as culprit and non-culprit according to imaging findings and patient clinical presentations. Univariate and multivariate analyses were performed to assess the difference between culprit and non-culprit lesions and complementary value of hrCMR in identifying higher risk lesions.
Results:
In total, 75 patients were included in this study. According to the morphology, lesions could be classified into five types: Type I, classical dissection (n = 50); Type II, fusiform aneurysm (n = 1); Type III, long dissected aneurysm (n = 3); Type IV, dolichoectatic dissecting aneurysm (n = 9) and Type V, saccular aneurysm (n = 12). Regression analyses showed that age and hypertension were both associated with culprit lesions (age: OR, 0.83; 95% CI 0.75-0.92; p < 0.001 and hypertension: OR, 66.62; 95% CI 5.91-751.11; p = 0.001). Hematoma identified by hrCMR was significantly associated with culprit lesions (OR, 16.80; 95% CI 1.01-280.81; p = 0.037). Moreover, 17 cases (16 lesions were judged to be culprit) were diagnosed as IAD but not visible in DSA and 15 were Type I lesion.
Conclusion:
hrCMR is helpful in visualizing and characterizing IAD. It provides a significant complementary value over DSA for the diagnosis of IAD.
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