Clinical Significance of Intraluminal Contrast Enhancement in Patients with Spontaneous Cervical Artery Dissection: A Black-Blood MRI Study

Abstract

ZUSAMMENFASSUNGZiel Kürzlich durchgeführte Studien zeigten, dass intraluminale Thromben der A. carotis interna in black-blood (BB)-MRSequenzen eine Kontrastmittelaufnahme zeigen. Ziel der Studie ist es, die Wertigkeit der intraluminalen Kontrastmittelaufnahme bei Patienten mit einer spontanen arteriellen Dissektion der Halsgefäße zu untersuchen. Material und Methoden ABSTR AC TPurpose Recent studies have suggested that intraluminal thrombi show contrast enhancement on carotid black-blood T1w MRI. The aim of this study was to evaluate the significance of intraluminal contrast enhancement (iCE) regarding symptom status in patients with spontaneous cervical artery dissection (sCAD).Methods 33 consecutive patients (19 men) with sCAD received a brain MRI (DIFF, T2w, T2*w, FLAIR) and a multi-sequence 3T-MRI with fat-saturated high-resolution black-blood T1w-sequences pre-and post-contrast, contrast-enhanced MR angiography and TOF images of carotid and vertebral arteries. Presence/absence of iCE, vessel occlusion and vessel wall hematoma (hyperintense in T1w pre-contrast) were analysed by two radiologists in consensus decision.Results 44 of 132 analysed vessels had a vessel wall hematoma, consistent with sCAD. In 17 of 44 dissected vessels an acute ischemic stroke was found. 16 of 17 (94.1 %) vessels ipsilateral to ischemic stroke demonstrated iCE, compared to 9 of 44 (20.4 %) dissected vessels without stroke (P< 0.001). The presence/absence of iCE resulted in a sensitivity, specificity, positive and negative predictive value and accuracy for ischemic stroke of 0. 94, 0.67, 0.64, 0.95, and 0.77, respectively, and an odds ratio of 32.0.Conclusion iCE, which is suggestive of intraluminal thrombus formation, is strongly correlated with ischemic symptoms in patients with sCAD. Key points▪ Intraluminal contrast enhancement is associated with cerebral ischemia in corresponding vessel territories in patients with cervical artery dissection. ▪ Our results suggest that intraluminal contrast enhancement represents intraluminal thrombus formation. ▪ Black-blood imaging might be useful to identify those patients with cervical artery dissection at higher risk for initial or recurrent stroke.

Low Diagnostic Yield of Routine Cerebrospinal Fluid Analysis in Juvenile Stroke

“…All imaging findings suspicious of cerebral vasculitis were documented. For diagnosis of arterial dissection, we routinely performed dissection sensitive MRI sequences (T1-weighted imaging with fat-saturation) ( 11 , 12 , 13 ).…”

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

“…However, it cannot visualize wall structure, including hematoma. Multi-contrast high-resolution, cardiovascular magnetic resonance (hrCMR) has been increasingly used to characterize arterial abnormality by visualizing both lumen morphology and wall structure, including atherosclerosis, dissection and vasculitis [ 3 , 7 , 8 ]. Many pilot studies have demonstrated its complementary values for the diagnosis of intracranial dissection over DSA, magnetic resonance angiography (MRA) and computed tomography angiography (CTA) by harnessing its excellent soft tissue contrast [ 3 , 9 – 11 ].…”

Magnetic resonance vessel wall imaging in cerebrovascular diseases

“…21 VWCE is evident in approximately two-thirds of dissections. 3,14,47,61 When present, this finding is thought to be due to inflammation, stasis of blood within the false lumen, or disruption of the vasa vasorum. 48,50 The enhancement pattern tends to be eccentric (< 50% circumference), 48,61 and may extend beyond the visualized dissection flap and/ or hematoma, suggesting farther-reaching injury to the intima than can be seen on noncontrasted sequences (Fig.…”

“…3 Extensive enhancement in cervical dissections may be associated with a heightened risk of multiple dissections and stroke, raising the question of whether these patients have a more severe vasculopathy. 14,47 However, VWCE is not a specific indicator of dissection, because this finding can be seen in areas without other evidence of vessel pathology. 3 Whether this represents an underlying vasculopathy that predisposes to dissection remains unclear.…”