High-Resolution Magnetic Resonance Imaging of Cervicocranial Artery Dissection

Abstract

Background and Purpose— We aimed to systematically investigate the characteristics of cervicocranial artery dissection (CCAD) on high-resolution magnetic resonance imaging that are associated with acute ischemic stroke. Methods— Patients with CCAD were recruited and divided into stroke and nonstroke groups. The lesion location, the presence of a double lumen, intimal flap, intramural hematoma, pseudoaneurysm, irregular surface, intraluminal thrombus, and other quantitative parameters of each dissected segment were reviewed. Multiple logistic regression was used to examine the association between imaging features of CCAD and ischemic stroke. Results— A total of 145 affected vessels from 118 patients with CCAD were analyzed. Anterior circulation, intramural hematoma, irregular surface, intraluminal thrombus, and severe stenosis (>70%) on high-resolution magnetic resonance imaging were more prevalent in CCAD patient with stroke (54.4% versus 36.4%; P =0.030, 96.2% versus 84.8%; P =0.017, 74.7% versus 37.9%; P <0.001, 44.3% versus 4.5%; P <0.001, and 54.4% versus 31.8%; P =0.008, respectively). In multivariable logistic regression analysis, the presence of irregular surface and intraluminal thrombus on imaging were independently associated with acute ischemic stroke in CCAD with odds ratios of 4.29 (95% CI, 1.61–11.46, P =0.004) and 7.48 (95% CI, 1.64–34.07, P =0.009). Conclusions— The current findings supported that the presence of irregular surface and intraluminal thrombus were related to stroke occurrence in patients with CCAD. High-resolution magnetic resonance imaging might give insights into pathogenesis of ischemic stroke in CCAD. It may be useful for individual prediction of ischemic stroke early in CCAD.

Image Findings of Acute to Subacute Craniocervical Arterial Dissection on Magnetic Resonance Vessel Wall Imaging: A Systematic Review and Proportion Meta-Analysis

“…After full-text reviews of these 19 articles, eight were excluded because they contained insufficient information in terms of the proportion of image findings of acute to subacute craniocervical AD on MR-VWI ( 2 , 5 , 6 , 23 – 27 ) and one because of suspected population overlap ( 28 ). Finally, 11 articles were included in the final analysis ( 4 , 7 – 15 , 29 ).…”

Intramural Hematoma Shape and Acute Cerebral Infarction in Intracranial Artery Dissection: A High-Resolution Magnetic Resonance Imaging Study

“…Artery dissection implies a tear in the wall of an artery, leading to intrusion of blood within the layers of arterial walls. An important pathological feature of symptomatic cervicocranial artery dissection is that the affected vessel wall becomes the nidus for distal embolization [16]. Different patterns of disruption of the endothelium, intima, and internal elastic lamina can result in an influx of circulating blood into the vessel wall layers.…”

“…Different patterns of intimal injury in IADs have been reported [13,15]. Previous studies reported that surface irregularity and intraluminal thrombus are independently related to stroke occurrence in patients with cervicocranial artery dissection and that the shape of carotid plaque is significantly associated with the presence of intraplaque hemorrhage [16,17]. We hypothesized that different shapes of IMH, according to the proximal and distal position of the hematoma, alter hemodynamics and have different clinical presentations.…”

Spontaneous Vertebral Artery Dissection Is an Under-Recognized Cause of Stroke in Young Patients: Two Case Reports and Review

“…Typical radiological features can be visualized with MRI, MRA, and CTA (case 1) as they are sensitive to detect intramural hematoma; however, some cases, especially intracranial VAD, will need confirmation by conventional angiography (case 2), if noninvasive techniques were not conclusive [12]. Recently, high-resolution MRI (HR-MRI) has been reported to offer the advantage of direct visualization both of vessel wall abnormalities and an intraluminal thrombus; however, most patients do not have access to such techniques [13].…”