Abstract
PurposeTo investigate the role of the diffusion weighted imaging (DWI) in the acute dissection of internal carotid artery (ICA) and vertebral artery (VA) and assessing the length of intramural hematoma (IMH), caused by dissection.MethodsWe analyzed 28 patients presenting with a dissection of the ICA and/or VA with respect to the presence of high signal intensity areas on DWI suggestive of dissection and 20 control subjects without arterial dissection, some with and some without atherosclerotic lesions. ICA or VA dissection was defined by clinical and imaging, computed tomography angiography (CTA), MR angiography (MRA), and digital subtraction angiography (DSA) findings. The length of DWI hyperintensity was compared to length of the occlusion or stenosis on the angiographic examination.ResultsIn 28 patients, 30 dissected arteries were analyzed. Time intervals from the onset of the first clinical symptoms to the radiological evaluation ranged from 1.5 h to 42 days. In 28 (93%) of the dissections, a high signal intensity of the affected artery was present on DWI. The measurement of the dissection length on DWI compared to DSA showed a mean deviation of 2.7 mm and a standard deviation of 3.7 mm.ConclusionDWI is a highly sensitive and valuable pulse sequence for the detection of dissected cervical arteries even in the first hours after symptom onset. In contrast to CTA and MRA, DWI can be a potential tool for a reliable measurement of the dissection length.
Highlights
Arterial dissection (AD) is characterized by an intima tear leading to an intramural hematoma and a subsequent splitting of vessel wall layers
We investigated the number of patients who developed an ischemic stroke due to CAD and the prevalence of stenosis and occlusions in CAD
In order to evaluate the accuracy of assessment of the dissection length, we calculated the absolute difference between the length of the diffusion weighted imaging (DWI) hyperintensity and the length of the dissection in magnetic resonance angiography (MRA), computed tomography angiography (CTA), and digital subtraction angiography (DSA) (Table 1)
Summary
Arterial dissection (AD) is characterized by an intima tear leading to an intramural hematoma and a subsequent splitting of vessel wall layers This causes a stenosis or an occlusion and potentially an aneurysmal dilatation of the vessel. Cervical (carotid or vertebral) artery dissection (CAD) frequently presents with unilateral head and neck pain and may accompanied by a partial Horner’s syndrome (oculosympathetic palsy) and followed in the hours or days by cerebral and/or retinal ischemia. This classic clinical triad is present in less than one third of patients. Magnetic resonance imaging (MRI) is capable of detecting intramural hematoma (IMH) on T2-weighted and fat suppressed T1-weighted images
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