Abstract
BackgroundDirect evidence of intimal flaps, double lumen and intramural haematomas (IMH) is difficult to detect on conventional angiography in most intracranial vertebrobasilar dissecting aneurysms (VBDAs). Our purpose was to assess the value of three-dimensional high-resolution magnetic resonance vessel wall imaging (3D HRMR VWI) for identifying VBDAs.MethodsBetween August 2013 and January 2016, consecutive patients with suspicious VBDAs were prospectively enrolled to undergo catheter angiography and VWI (pre- and post-contrast). The lesion was diagnosed as definite VBDA when presenting direct signs of dissection; as possible when only presenting indirect signs; and as segmental ectasia when there was local dilation and wall thickness similar to adjacent normal artery’s without mural thrombosis.ResultsTwenty-one patients with 27 lesions suspicious for VBDAs were finally included. Based on findings of VWI and catheter angiography, definite VBDA was diagnosed in 25 and 7 lesions (92.6%, vs 25.9%, p < 0.001), respectively; possible VBDA in 0 and 20 (0 vs 74.1%), respectively; and segmental ectasia in 2 and 0 (7.4% vs 0%), respectively. On VWI and catheter angiography, intimal flap was detected in 21 and 7 lesions (77.8% vs 25.9%, p = 0.001), respectively; double lumen sign in 18 and 7 (66.7% vs 25.9%, p = 0.003), respectively; and IMH sign in 14 and 0 (51.9% vs 0), respectively.Conclusions3D HRMR VWI could detect direct dissection signs more frequently than catheter angiography. This may help obtain definite diagnosis of intracranial VBDAs, and allow accurate differentiation between dissecting aneurysm and segmental ectasia as well. Further prospective study with larger sample was required to investigate the superiority of HRMR VWI for definite diagnosis of intracranial VBDAs than catheter angiography.
Highlights
Direct evidence of intimal flaps, double lumen and intramural haematomas (IMH) is difficult to detect on conventional angiography in most intracranial vertebrobasilar dissecting aneurysms (VBDAs)
Further prospective study with larger sample was required to investigate the superiority of HRMR three-dimensional high-resolution magnetic resonance vessel wall imaging (VWI) for definite diagnosis of intracranial VBDAs than catheter angiography
Patient selection All the patients were consecutively enrolled from August 2013 to January 2016 to undergo catheter angiography and 3D HRMR VWI, when they fulfilled the following criteria: 1) clinical symptoms and findings on computed tomographic angiography (CTA) or MRA suggestive of an intracranial VBDA; 2) no contraindication for MR imaging and catheter angiography
Summary
Direct evidence of intimal flaps, double lumen and intramural haematomas (IMH) is difficult to detect on conventional angiography in most intracranial vertebrobasilar dissecting aneurysms (VBDAs). Our purpose was to assess the value of three-dimensional high-resolution magnetic resonance vessel wall imaging (3D HRMR VWI) for identifying VBDAs. Intracranial vertebrobasilar dissecting aneurysms (VBDAs) are not uncommon, and may exhibit intimal flaps, double lumens and intramural haematoma (IMH) [1]. Catheter angiography generally provides intensity projection images, not the cross-sectional images, which limits the capability for detecting these characteristic signs of dissection [2, 3], and often reveals pearl and string sign, fusiform or serpentine dilation, even perhaps an arterial occlusion [3]. High resolution magnetic resonance vessel wall imaging (HRMR VWI) could provide cross-sectional images, and has been increasingly used in intracranial artery diseases [4]. The identification may be impaired given the inherent curvature of intracranial arteries, limited anatomic coverage, and anisotropic spatial resolution [5, 6], leading to falsenegative results, especially for cases involving 2 or more vessels [3]
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