Feasibility of high-resolution MR imaging for the diagnosis of intracranial vertebrobasilar artery dissection

Han, Miran; Rim, Nae-Jung; Lee, Jin Soo; Kim, Sun Yong; Choi, Jin Wook

doi:10.1007/s00330-014-3296-5

Cited by 70 publications

(76 citation statements)

References 20 publications

(32 reference statements)

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“…The stroke mechanisms were classified by modifying the TOAST (Trial of Org 10172 in acute stroke treatment) classification: large artery atherosclerosis, small vessel occlusion, cardioembolism and dissections [5, 6]. Large artery atherosclerosis was divided according to the site of significant (>50%) stenosis at the relevant distal or proximal VA. Dissection was diagnosed based on the clinical and imaging findings of MR angiography, CT angiography, high-resolution MR or digital subtraction angiographies [7, 8]. The common LMI manifestations – vertigo/dizziness, nystagmus, headache, facial palsy, dysarthria, dysphagia, sensory changes, ataxia, hoarseness and hiccup were recorded.…”

Section: Methodsmentioning

confidence: 99%

Lateral Medullary Infarction with or without Extra-Lateral Medullary Lesions: What Is the Difference?

et al. 2018

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Background: Lateral medullary infarction (LMI) is not an uncommon disease. Although lesions are usually restricted to the lateral medullary area, some patients have additional infarcts in other parts of the brain. The clinical features and prognosis of isolated LMI (pure LMI, LMIpr) have been investigated. However, it remains unclear whether clinical characteristics, prognosis and factors associated with prognosis differ between patients with LMIpr and those with additional lesions (LMI plus, LMIpl). Methods: Patients with LMI identified by MRI were enrolled. The demographic and clinical characteristics, in-hospital outcome (intensive care unit [ICU] admission, pneumonia and modified Rankin scale [mRS] at discharge), and long-term residual symptoms (vertigo/dizziness, sensory disturbances, dysphagia) and outcomes (occurrence of stroke, acute coronary syndrome [ACS], death, and mRS at follow-up) were compared between LMIpr and LMIpl patients. Factors associated with poor functional outcome (mRS 2–6) at the follow-up were analyzed. Results: Among 248 LMI patients, 161 (64.9%) had LMIpr and 87 (35.1%) had LMIpl. During admission, patients with LMIpl more frequently experienced ICU care, pneumonia and had a higher discharge mRS (3 vs. 2; p < 0.001) than LMIpr patients. The occurrence of stroke, ACS, frequency of death and functional outcome was not different during follow-up. However, residual neurologic symptoms such as dizziness (p = 0.002), dysphagia (p = 0.04) and sensory symptoms (p < 0.001) were more frequent in LMIpr than in LMIpl patients. In LMIpr patients, the rostral location of LMI was associated with poor functional outcome (p = 0.041), whereas in LMIpl patients, the presence of medial posterior-inferior cerebellar artery lesion was associated with good functional outcome (p = 0.030). Conclusion: Although the short-term outcome is poorer in LMIpl than LMIpr patients, long-term residual symptoms are more common in LMIpr patients. The location of the LMI and extra-medullary lesion affects the long-term functional outcome of LMIpr and LMIpl patients respectively.

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Section: Methodsmentioning

confidence: 99%

Lateral Medullary Infarction with or without Extra-Lateral Medullary Lesions: What Is the Difference?

et al. 2018

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“…In one study 81 a dissection fl ap could be identifi ed on MRI in more than 90% of patients with clinical symptoms and CT angiography fi ndings of a possible intracranial artery dissection. A mural haematoma was identifi ed in more than 50% of these patients.…”

Section: Clinical Presentation and Radiological Featuresmentioning

confidence: 99%

Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection

Debette¹,

Compter²,

Labeyrie³

et al. 2015

The Lancet Neurology

343

318

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Spontaneous intracranial artery dissection is an uncommon and probably underdiagnosed cause of stroke that is defi ned by the occurrence of a haematoma in the wall of an intracranial artery. Patients can present with headache, ischaemic stroke, subarachnoid haemorrhage, or symptoms associated with mass eff ect, mostly on the brainstem. Although intracranial artery dissection is less common than cervical artery dissection in adults of European ethnic origin, intracranial artery dissection is reportedly more common in children and in Asian populations. Risk factors and mechanisms are poorly understood, and diagnosis is challenging because characteristic imaging features can be diffi cult to detect in view of the small size of intracranial arteries. Therefore, multimodal follow-up imaging is often needed to confi rm the diagnosis. Treatment of intracranial artery dissections is empirical in the absence of data from randomised controlled trials. Most patients with subarachnoid haemorrhage undergo surgical or endovascular treatment to prevent rebleeding, whereas patients with intracranial artery dissection and cerebral ischaemia are treated with antithrombotics. Prognosis seems worse in patients with subarachnoid haemorrhage than in those without.

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“…Moreover, DSA is an invasive procedure with risks, including vascular injury and intracerebral complications [9] . It has recently been reported that high-resolution magnetic resonance imaging (HR-MRI) may be superior to DSA in the diagnosis of IVAD because the imaging modality has superior detection of the direct signs [6,7] .…”

Section: Introductionmentioning

confidence: 99%

“…IVAD is the most common (67.1-78.0%), spontaneous, intracranial artery dissection found in Asian populations [4,5] . Although digital subtraction angiography (DSA) has been the gold standard in the diagnosis of intracranial arterial dissection [6] , luminal angiography including DSA is disadvantageous in the depiction of the direct signs of dissection, such as a double lumen or an intimal flap [6][7][8] . Moreover, DSA is an invasive procedure with risks, including vascular injury and intracerebral complications [9] .…”

Section: Introductionmentioning

confidence: 99%

Multi-Contrast High-Resolution Magnetic Resonance Findings of Spontaneous and Unruptured Intracranial Vertebral Artery Dissection: Qualitative and Quantitative Analysis According to Stages

Park

Jung²,

Kim³

et al. 2016

Cerebrovasc Dis

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Background: Although high-resolution magnetic resonance imaging (HR-MRI) has been used as a strong imaging method for diagnosing intracranial vertebral artery dissection (IVAD), the diagnosis is sometimes challenging because a dissection has geometric changes in the natural course. The radiologic features may change or disappear over time, which makes the diagnosis confusing. Our study was to present radiological findings according to the stages in spontaneous and unruptured, IVAD on 3T HR-MRI and to guide the age estimation of IVAD with the distinguishing findings according to the stages. Methods: From January 2011 to July 2014, the 41 vertebral arteries (M:F = 18:12; age range 32-67 years) were retrospectively enrolled. Spontaneous, unruptured IVAD was diagnosed if it had a clear onset based on clinical and radiological findings. The stages were classified as acute (0-3 days), early subacute (3-10 days), late subacute (10-60 days) and chronic stage (>60 days; recovery and non-recovery groups) according to the time intervals from symptom onset, based on the prior published studies. HR-MR findings were assessed and compared in the intimal flap, double lumen, aneurysmal dilatation (maximal outer diameter, maximal wall thickness, wall thickness index and remodeling index), intramural hematoma (relative signal intensity) and vessel wall enhancement according to the stages with qualitative and quantitative methods. Two radiologists analyzed the HR-MR findings with consensus reading. Results: IVAD was classified into acute (n = 6), early subacute (n = 8), late subacute (n = 16) and chronic (n = 11) stages. HR-MR dissection findings such as intimal flap, double lumen, aneurysmal dilatation and intramural hematoma significantly decreased from the earlier stages to the chronic stage (p < 0.05). The quantitative indices in aneurysmal dilatation and the relative signal intensity of intramural hematoma showed significant higher values in the earlier stages followed by a significant decrease in the chronic stage recovery group (p < 0.05). The degree of vessel wall enhancement was higher in the earlier stage and decreased in the chronic stage (p < 0.05), but mild vessel wall enhancement was identified 900 days after symptom onset. Conclusion: The 3T HR-MRI reveals the vessel wall characteristics and provides distinguishing findings between earlier stages and the chronic stage in spontaneous and unruptured IVAD. Characterization of these radiological findings according to stages may assist with the age estimation of the dissection and may help to understand IVAD as a whole.

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Feasibility of high-resolution MR imaging for the diagnosis of intracranial vertebrobasilar artery dissection

Abstract: Direct imaging findings of dissection were well visualised by HR-MRI. Detection of a dissection flap on CE-T1WI is the most reliable diagnostic finding. HR-MRI could be a useful diagnostic tool for intracranial VBDs.

Cited by 70 publications

References 20 publications

Lateral Medullary Infarction with or without Extra-Lateral Medullary Lesions: What Is the Difference?

Lateral Medullary Infarction with or without Extra-Lateral Medullary Lesions: What Is the Difference?

Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection

Multi-Contrast High-Resolution Magnetic Resonance Findings of Spontaneous and Unruptured Intracranial Vertebral Artery Dissection: Qualitative and Quantitative Analysis According to Stages

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