Cervical internal carotid artery dissecting hemorrhage: diagnosis using MR.

Abstract

Two men underwent high-resolution magnetic resonance (MR) imaging of the internal carotid artery (ICA) 12 and 16 days after spontaneous dissection of this vessel. One underwent follow-up MR imaging 7 weeks later. T1-weighted images were obtained in both cases, and T2-weighted images were obtained in one patient. In both cases, the MR findings corresponded to the angiographic abnormalities. On both the T1- and T2-weighted images, there was a hyperintense lesion expanding the wall and narrowing the lumen of the ICAs. Follow-up MR imaging showed complete resolution of the mural lesion. Axial images best demonstrated the anatomic and MR signal alterations. The hyperintensity of the lesion on both T1- and T2-weighted images indicated a short T1 and a long T2 as expected in a subacute hematoma. High-resolution MR imaging, therefore, can specifically demonstrate a thrombosed carotid dissection noninvasively at least as early as 12 days. The potential to diagnose carotid dissection in the acute phase using high-field-strength MR imaging and its importance for the prevention of embolic strokes are also discussed.

Comparison of Multidetector CT Angiography and MR Imaging of Cervical Artery Dissection

“…Evolution of the hematoma within a vessel wall has not been extensively studied, but it is possible that high T1 signal intensity may not be present during the early acute period. 15,21,22 T2-weighted sequences (with or without fat saturation) may add sensitivity for the diagnosis of dissection in the setting of absent or equivocal findings on T1-weighted imaging, to evaluate hyperacute blood or wall edema.…”

Characterization of Craniocervical Artery Dissection by Simultaneous MR Noncontrast Angiography and Intraplaque Hemorrhage Imaging at 3T

“…[11][12][13] However, acquisition of 2D T1-weighted images is time-consuming and has limited longitudinal coverage. Recently, the 3D black-blood T1-weighted imaging technique has been used to detect IMH in patients with arterial dissection.…”

“…Previous studies reported that the signal of IMH will change with time on MR vessel wall imaging. 13,22 To evaluate the usefulness of SNAP imaging in the characterization of CCAD, further prospective studies with larger sample sizes are warranted.…”

“…10 MR vessel wall imaging has been increasingly used for the diagnosis of CCAD due to its capability of directly visualizing IMH in the vessel wall. [11][12][13] Recently, a multisequence MR imaging protocol, which includes both MRA and MR vessel wall imaging sequences, was recommended for the diagnosis of CCAD. 10 However, this protocol needs independent acquisition of 2 different timeconsuming MR imaging sequences.…”

Noninvasive monitoring of internal carotid artery dissection.

“…- 29 Finally, in the near future, the combination of MR angiography of the carotid artery including the distal cervical and intracranial segments with the assessment of characteristic flow dynamics by duplex Doppler and the display of the vascular wall hemorrhage on MR scans will probably limit the use of conventional angiography to a few selected cases.…”