Abstract
BackgroundIntracranial 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.MethodsImaging 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.ResultsIn 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.ConclusionhrCMR is helpful in visualizing and characterizing IAD. It provides a significant complementary value over DSA for the diagnosis of IAD.
Highlights
Intracranial artery dissection (IAD) often causes headache and cerebral vascular ischemic events
The exclusion criteria were [14]: (1) dissection accompanied by other cerebral vasculopathies, including extracranial or intracranial atherosclerotic arteries with ≥ 50% stenosis, vasculitis, Moya-Moya disease, fibromuscular dysplasia; (2) chronic ischemic symptoms (> 12 weeks); (3) ascending aortic arch atheroma; (4) suspected cardio-embolic stroke; (5) previous strokes or transient ischemic attacks (TIA); (6) known coagulopathy or renal dysfunction; and (7) clinical contraindications to CMR
Overall lesion characteristics on high resolution cardiovascular magnetic resonance imaging IADs involved in this study could be classified into five different types according to morphological features (Table 2 with schematic drawings and representative cases shown in Fig. 2): classical dissection [Type I; n = 50 (66.7%)], fusiform aneurysm [Type II; n = 1 (1.3%)], long dissected aneurysm [Type III; n = 3 (4.0%)], dolichoectatic dissecting aneurysm [Type IV; n = 9 (12.0%)] and saccular aneurysm [Type V; n = 12 (16.0%)]
Summary
Intracranial artery dissection (IAD) often causes headache and cerebral vascular ischemic events. Intracranial artery dissection (IAD) is the occurrence of a hematoma in an intracranial arterial wall induced by the split of its layers It often causes headache and cerebral vascular ischemic events due to hemodynamic impairment that is different from extracranial dissection, Shi et al J Cardiovasc Magn Reson (2021) 23:74 which more often causes thromboembolism [1, 2]. IAD accounts for a small percentage (1–2%) of all ischemic strokes [3] and is classified according to modified TOAST criteria [3, 4] It is, an important cause (10–20%) of stroke in young and middle-aged adults, especially in the Asian population [5, 6].
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