Abstract TP218: Black-Blood MRI; Efficacy in the Diagnosis of Cerebral Arterial Dissection and Changes Over Time

Abstract

Background: Cerebral arterial dissection is considered a rare disease, but recent advances in diagnostic imaging have increased the likelihood of its diagnosis. In particular, Black-Blood (BB) MRI T1 weighted imaging (BB-MRI) enables the diagnosis of cerebral arterial dissection by reducing the signal in the vascular lumen and detecting a high signal from the hematoma in the false lumen. However, the changes in the hematoma over time are still unknown. In this study, these changes were investigated retrospectively. Methods: This study included patients who were admitted to the Stroke Department of the Japanese Red Cross Okayama Hospital from April 2015 to May 2019 and diagnosed with cerebral arterial dissection at discharge based on the imaging criteria of the spontaneous cervicocephalic arterial dissections study-Japan (SCADS-J). The ratios of the signal intensity from the arterial dissection sites to the signal intensity from the normal blood vessel walls (BB-ratio = dissected vessel wall T1 value/normal vessel wall T1 value) were calculated based on when the B-MRI images were taken. The period from the onset of the disease was analyzed. Results: During this study, 646 acute stroke patients were hospitalized, and cerebral arterial dissection was confirmed at discharge in 16 patients (mean age, 57 years; 14 men) based on the diagnostic imaging criteria of the SCADS-J. For the 12 patients who underwent BB-MRI within 1 week of onset, the BB-ratio increased over the first week and peaked at a median of 10.5 days (1st IQR 8.75-3rd 15.25), with a mean BB-ratio of 3.35 (SD 1.00). Discussion: The signal intensity of the BB-MRI T1 weighted images for intramural hematoma increased 1 week after the onset of cerebral arterial dissection. Therefore, diagnoses must account for the length of time elapsed since disease onset.