3D T1-weighted black blood sequence at 3.0 Tesla for the diagnosis of cervical artery dissection

Abstract

ObjectiveWe aimed to investigate the value of three-dimensional (3D) T1 volumetric isotropic turbo spin echo acquisition (VISTA) in the diagnosis of cervical artery dissection (CAD).MethodsWe prospectively included patients who were suspected as having a CAD within 1 month of onset. For T1 VISTA, the diagnosis of the dissection was based on the presence of intramural high-signal, intimal flap, double lumen and aneurysmal dilation. The final diagnosis of dissection was based on the clinical history, physical examination, and all of the imaging tests.ResultsA total of 46 patients were included in this study. The final diagnosis of CAD was made for 21 patients. Diagnosis of dissection was made for 20 of the 21 patients after assessing T1 VISTA. A definitive diagnosis of dissection was not made for 5 patients (including 3 patients with digital subtraction angiography) before the T1 VISTA examination. The sensitivity and specificity for T1 VISTA were 95.2% (95% CI, 76.2% to 99.9%) and 100% (95% CI, 86.3% to 100%), respectively. The agreement between the two researchers for T1 VISTA for diagnosis of CAD was very good (k=0.91). For patients without acute artery occlusion, all of them had a definite conclusion with or without dissection by T1 VISTA (n=29). However, for 17 patients with acute artery occlusion, the possibility of dissection could not be excluded for 6 of them by T1 VISTA (p=0.001).Conclusions3D T1 VISTA at 3.0 Tesla was useful in the diagnosis of acute CAD. However, for some patients with total occlusion of the artery without typical imaging features of dissection, the unequivocal distinction between intramural haematoma and intraluminal thrombus may be not adequate by T1 VISTA alone. Future studies should investigate whether a follow-up scan, a contrast-enhanced imaging or an optimal VISTA technique could be useful.

Cervical artery dissection—an easily neglected cause of stroke: a case report

“…When dissection does not cause any alteration in the arterial lumen, it may lead to false negative in patients with CAD. A study shows that the 3D-T1 VISTA sequence is useful in the diagnosis of CAD it can show intramural hematoma of the cervical artery clearly [ 10 ]. It is worth pointing out that VW-MRI can not only display the lumen, but also image the vessel wall, it is helpful for further analyze the composition of plaque, judge the cause of stenosis and provide a direct imaging basis for clinical diagnosis and treatment.…”

Magnetic Resonance Imaging and Clinical Factors Associated With Ischemic Stroke in Patients Suspected of Cervical Artery Dissection

“…In small feasibility studies, 3D T1 CUBE, 3D SNAP, and 3D T1 BB VISTA/SPACE were used to detect IMH, but these studies lacked comparison to 2D T1-weighted TSE and evaluation of IMH-related stroke. 28, 35, 36 While some studies have shown that 3D T1-weighted sequences can improve signal and contrast to noise ratios over 2D T1-weighted TSE, these again were too small to show significant improvements, and moreover did not evaluate stroke risk with IMH. 37, 38…”

The Added Value of Vessel Wall MRI in the Detection of Intraluminal Thrombus in Patients Suspected of Craniocervical Artery Dissection

“…Since no single reference standard for the diagnosis of CCAD was available, the final diagnosis results based on the clinical information, image data sets, and the results of follow-up were chosen to be the reference standard in the current study [ 20 - 22 ]. The final diagnosis of CCAD is a consensus of the attending neuroradiologists, neurosurgeries, and neurologists.…”