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. 2022 Jul 5:14:785661.
doi: 10.3389/fnagi.2022.785661. eCollection 2022.

Three-Dimensional High-Resolution Magnetic Resonance Imaging for the Assessment of Cervical Artery Dissection

Xianjin Zhu  1 , Yi Shan  2   3 , Runcai Guo  4 , Tao Zheng  3 , Xuebin Zhang  4 , Zunjing Liu  3 , Kunpeng Liu  5
Affiliations

Three-Dimensional High-Resolution Magnetic Resonance Imaging for the Assessment of Cervical Artery Dissection

Xianjin Zhu et al. Front Aging Neurosci. .

Abstract

Background and purpose: Diagnosing cervical artery dissection (CAD) is still a challenge based on the current radiographic criteria. This study aimed to assess the value of three-dimensional high-resolution magnetic resonance imaging (3D HRMRI) in the detection of the signs of CAD and its diagnosis.

Materials and methods: Patients with CAD from January 2016 to January 2021 were recruited from our 3D HRMRI database. The signs of dissection (intramural hematomas, intimal flap, double lumen), length and location of the dissection, thickness of the intramural hematoma, intraluminal thrombus, and percentage of dilation of the outer contour of the dissection on 3D HRMRI were assessed.

Results: Fourteen patients with 16 CADs, including 12 carotid CADs and 4 vertebral CADs, were finally diagnosed in this study. On 3D HRMRI, intramural hematomas were detected in 13/16 (81.3%) lesions with high sensitivity (100%) and high specificity (100%). Intimal flaps were found in 9/16 (56.3%) lesions with moderate sensitivity (64.3%) and high specificity (88.9%). Double lumen signs were observed in 4/16 (25.0%) lesions with high sensitivity (80.0%) and high specificity (100%). In addition, concomitant intraluminal thrombus were detected in 4/16 (25.0%) lesions with high sensitivity (80.0%) and high specificity (100%). The mean length of dissection was (25.1 ± 13.7) mm. The mean thickness of the intramural hematoma was (4.3 ± 2.3) mm. The mean percentage of dilation for the outer contour of the dissection was (151.3 ± 28.6)%.

Conclusion: The 3D HRMRI enables detection of the dissecting signs, such as intramural hematoma, intimal flap, double lumen, and intraluminal thrombus with high sensitivity and specificity, suggesting a useful, and non-invasive tool for definitively diagnosing CAD.

Keywords: cervical artery dissection; double lumen; high resolution magnetic resonance image; intimal flap; intramural hematoma.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer QY declared a shared parent affiliation with the authors, XJZ to the handling editor at the time of review.

Figures

FIGURE 1
FIGURE 1
Bilateral acute ischemic stroke associated with dissection in the internal carotid arteries (ICA) bilaterally. Diffusion-weighted imaging (DWI) showed acute ischemic stroke in bilateral hemispheres (A,B, arrow). Digital subtraction angiography (DSA) only showed occlusion in the right ICA (C, arrow) and mild irregular stenosis in the left ICA (D, arrow) without any direct dissecting signs. Initial magnetic resonance angiography (MRA) displayed occlusion (E, empty arrow) in the right ICA and mild irregular stenosis in the left ICA (E, arrow), similar as the founding on DSA. Initial coronal T1-weighted high-resolution magnetic resonance imaging (HRMRI) demonstrated a T1-hyperintense intramural hematoma (F, arrow) in the proximal C1 segments of the ICA bilaterally and a T1-hyperintense intraluminal thrombus in the middle and distal right ICA (F, empty arrow). Transverse HRMRI presented with typical crescent-shaped intramural hematomas (G, arrow). Follow-up MRA showed partial recanalization in the middle and distal right ICA (H, empty arrow) and a nearly normal lumen in the left ICA (H, arrow). Follow-up coronal HRMRI exhibited disappearance of the T1-hyperintense intramural hematoma (I, arrow) in the ICA bilaterally and T1-hyperintense intraluminal thrombus (I, empty arrow) in the right ICA.
FIGURE 2
FIGURE 2
Acute ischemic stroke (A, arrow) in the territory of the right ICA. Digital subtraction angiography (DSA) showed aneurysmal dilation with focal stenosis (B,C, empty arrow) and suspicious intimal flap (B, arrow) in the right ICA. Initial MRA displayed tapered stenosis (D, empty arrow) and a suspicious hematoma (D, arrow). Initial HRMRI showed an intramural hematoma on the T1-weighted coronal (E, arrow) and transverse image (F, arrow). Follow-up MRA (G, arrow) showed partial recanalization on the affected arterial lumen. The intramural hematoma had disappeared on follow-up T1-weighted coronal (H, arrow) and transverse (I, arrow) HRMRI.
FIGURE 3
FIGURE 3
Spiral intramural hematoma in the patient with vertebral artery dissection. Digital subtraction angiography (DSA) showed irregularly mild stenosis without any dissecting signs on anteroposterior and lateral projections (A,B, arrow). T1-weighted HRMRI showed an spiral intramural hematoma in the right vertebral artery in the coronal (C, arrow) and transverse planes (D, arrow).
FIGURE 4
FIGURE 4
Acute ischemic stroke associated with vertebral artery dissection. (A–C) Multiple acute ischemic stroke lesions in the parietooccipital junction bilaterally (A, arrow) with dissection in the right vertebral artery and left ICA. T1-weighted HRMRI showed an intramural hematoma in the right vertebral artery (B,C, arrow) and left ICA (B,C, empty arrow) in the coronal and transverse planes. (D–F) Acute ischemic stroke in the right cerebellum (D, arrow) with V3 segment dissection of the right vertebral artery. T1-weighted HRMRI showed an intramural hematoma in the right vertebral artery in the coronal (E, arrow), and transverse (F, arrow) planes.
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