Rapid Diagnosis of Carotid Intramural Hematoma with HR-MRI

Abstract

Carotid intramural hematoma, a type of carotid artery dissection, is hard to detect with traditional imaging examinations including color ultrasonography, computed tomography angiography (CTA), and digital subtraction angiography (DSA) because of the unaffected tunica intima. In this article, we report and discuss two cases of carotid intramural hematoma. In the first case, the patient experienced sudden-onset dysarthria with difficulty chewing and sucking. The diagnosis of ischemic stroke was further supported with the clinical presentation, physical examination, and a head CT scan. Later, the head and neck CTA examination detected the left carotid vessel had an irregular vascular wall and luminal stenosis, which was ultimately confirmed as intramural hematoma after performing neck high-resolution MRI (HR-MRI). Another patient was rapidly diagnosed with acute ischemic stroke using a head MRI scan, but the qualitative nature of the responsible vessel could not be distinguished by CTA and DSA. They could only demonstrate full occlusion of the carotid artery. HR-MRI was needed to identify the intramural hematoma-type ICA dissection. In conclusion, compared with CTA and DSA, HR-MRI is a cost-effective imaging examination with high resolution and easy repeatability. It can more accurately determine the nature of the vascular wall, the relationship of vessels and surrounding tissues, and effectively assists in the clinical judgement for intramural hematoma and other atypical carotid artery dissections.