Identification of high risk clinical and imaging features for intracranial artery dissection using high-resolution cardiovascular magnetic resonance

Journal of Cardiovascular Magnetic Resonance

David Saloner¹  Zakaria Meddings²  Zhongzhao Teng³  Xia Tian⁴  Jing Li⁴  Jianping Lu⁴  Bing Tian⁴  Qi Liu⁴  Xuefeng Zhang⁴  Zhang Shi⁵ 

[1] Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA;Department of Radiology, Addenbrooks’ Hospital, University of Cambridge, Cambridge, UK;Department of Radiology, Addenbrooks’ Hospital, University of Cambridge, Cambridge, UK;Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China;Department of Radiology, Changhai Hospital, Naval Medical University, 10 Building, 168 Changhai Road, Yangpu, 200433, Shanghai, China;Department of Radiology, Changhai Hospital, Naval Medical University, 10 Building, 168 Changhai Road, Yangpu, 200433, Shanghai, China;Department of Radiology, Addenbrooks’ Hospital, University of Cambridge, Cambridge, UK;

关键词: Intracranial artery dissection;    Stroke;    Cardiovascular magnetic resonance;    MRI;    Intramural hematoma;   

DOI  :  10.1186/s12968-021-00766-9

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY