Abstract
Extracranial CAD accounts for nearly 20% of cases of stroke in young adults. The mural hematoma frequently extends cranially to the petrous carotid segment in cCAD or is distally located in vCAD. We hypothesized that standard brain MR imaging could allow the early detection of CAD of the upper portion of carotid and vertebral arteries. Our prospectively maintained stroke data base was retrospectively queried to identify all patients with the final diagnosis of CAD. In the 103 consecutive patients studied, analysis of cervical fat-suppressed T1-weighted sequences demonstrated that the mural hematoma was located in the FOV of brain MR imaging in 77 patients. Subsequent to enrollment of a patient, a control patient was extracted from the same data base, within a similar categories for sex, age, NIHSS score, and stroke on DWI. Two blinded observers independently reviewed the 5 brain MR sequences of each examination and determined whether a CAD was present. Fifty-nine of the 77 patients with CAD (76.6%) and 73 of the 77 patients without CAD (94.8%) were correctly classified. Brain MR imaging demonstrated cCAD more frequently than vCAD in 54/58 (93.1%) and 5/19 (26.3%) patients, respectively, (P < .0001). Initial brain MR imaging can correctly suggest CAD in more than two-thirds of patients. This may have practical implications in patients with stroke with delayed cervical MRA or in those who are not initially suspected of having CAD.
Highlights
MethodsOur prospectively maintained stroke data base was retrospectively queried to identify all patients with the final diagnosis of CAD
Extracranial CAD accounts for nearly 20% of cases of stroke in young adults.[1,2]
The fact that the readers performed significantly better than the radiologists in the initial brain MR imaging report (77% versus 23%) supports the contention that the interpretation of direct signs of CAD on brain MR imaging is a learnable skill; the excellent interobserver agreement between a senior neuroradiologist and a resident with Ͻ3 months’ experience in neuroimaging demonstrates that the interpretation of highly conspicuous imaging findings requires little specialized training and can be achieved in regular clinical practice
Summary
Our prospectively maintained stroke data base was retrospectively queried to identify all patients with the final diagnosis of CAD. The manuscript was prepared in accordance with the STARD guidelines.[7] Our case-control study was nested within a longitudinal cohort of patients referred to our institution for suspected acute stroke or TIA, between January 2002 and December 2007. This prospectively maintained data base was retrospectively queried to identify all consecutive patients with the final diagnosis of CAD (n ϭ 125).
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