Age determination of vessel wall hematoma in spontaneous cervical artery dissection: A multi-sequence 3T Cardiovascular Magnetic resonance study

Abstract

BackgroundPreviously proposed classifications for carotid plaque and cerebral parenchymal hemorrhages are used to estimate the age of hematoma according to its signal intensities on T1w and T2w MR images. Using these classifications, we systematically investigated the value of cardiovascular magnetic resonance (CMR) in determining the age of vessel wall hematoma (VWH) in patients with spontaneous cervical artery dissection (sCAD).Methods35 consecutive patients (mean age 43.6 ± 9.8 years) with sCAD received a cervical multi-sequence 3T CMR with fat-saturated black-blood T1w-, T2w- and TOF images. Age of sCAD was defined as time between onset of symptoms (stroke, TIA or Horner's syndrome) and the CMR scan. VWH were categorized into hyperacute, acute, early subacute, late subacute and chronic based on their signal intensities on T1w- and T2w images.ResultsThe mean age of sCAD was 2.0, 5.8, 15.7 and 58.7 days in patients with acute, early subacute, late subacute and chronic VWH as classified by CMR (p < 0.001 for trend). Agreement was moderate between VWH types in our study and the previously proposed time scheme of signal evolution for cerebral hemorrhage, Cohen's kappa 0.43 (p < 0.001). There was a strong agreement of CMR VWH classification compared to the time scheme which was proposed for carotid intraplaque hematomas with Cohen's kappa of 0.74 (p < 0.001).ConclusionsSignal intensities of VWH in sCAD vary over time and multi-sequence CMR can help to determine the age of an arterial dissection. Furthermore, findings of this study suggest that the time course of carotid hematomas differs from that of cerebral hematomas.

Aneurysm wall enhancement on magnetic resonance imaging as a risk factor for progression of unruptured vertebrobasilar dissecting aneurysms after reconstructive endovascular treatment

“…The aneurysm size was larger in the enhancement group than in the no-enhancement group in the present study, although this difference did not reach statistical significance. According to a study of cervical artery dissection by Habs and colleagues, 3 the signal intensity of the dissecting wall varies over time; however, our study proves that there is no significant relationship between the signal intensity of the dissecting wall and the period from onset to MRI performance. One possible explanation for this difference is that our study included a limited number of samples and most of patients had a late subacute or chronic stage VBDA.…”

“…The VBDA stages were classified as acute (0-3 days), early subacute (3-10 days), late subacute (10-60 days), and chronic (> 60 days) according to the time interval from symptom onset as described in previously published studies. 3,10 Patient baseline information including age, sex, comorbidities (hypertension, diabetes, hyperlipidemia), smoking, and stages of VBDAs were recorded.…”

Intracranial Vessel Wall MRI: Principles and Expert Consensus Recommendations of the American Society of Neuroradiology

“…44,45 Among 7 patients with intracranial vertebral-basilar dissection, no patient had vessel wall hyperintensity on T1-weighted VW-MR imaging within a week of symptom onset, but 5 patients had hyperintensity in a subsequent week.…”

Internal carotid artery dissection as a cause of severe ischemic stroke with lethal outcome

“…Представленному больному исследование проводилось в более ранние сроки -на 2-й день заболевания, когда ИМГ в режиме Т1 имеет изоинтенсивный сигнал и плохо визуализи-руется. В эти сроки наибольшее дифференциально-диагностическое значение имеет режим Т2, в кото-ром интенсивность сигнала от ИМГ варьирует от пониженной до изоинтенсивной или же слабо по-вышенной, тогда как внутриартериальный тромб имеет неизменно гиперинтенсивный сигнал [14]. Сигнальные характеристики окклюзированной правой ВСА у больного соответствовали диссекции, а не тромбозу (см.…”