Three-Dimensional High-Resolution Magnetic Resonance Imaging for the Assessment of Cervical Artery Dissection

Xianjin Zhu; Yi Shan; Runcai Guo; Tao Zheng; Xuebin Zhang; Zunjing Liu; Kunpeng Liu

doi:10.3389/fnagi.2022.785661

Three-Dimensional High-Resolution Magnetic Resonance Imaging for the Assessment of Cervical Artery Dissection

Front Aging Neurosci. 2022 Jul 5:14:785661. doi: 10.3389/fnagi.2022.785661. eCollection 2022.

Authors

Xianjin Zhu¹, Yi Shan^{2

3}, Runcai Guo⁴, Tao Zheng³, Xuebin Zhang⁴, Zunjing Liu³, Kunpeng Liu⁵

Affiliations

¹ Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
² Graduate School of Peking Union Medical College, Beijing, China.
³ Department of Neurology, China-Japan Friendship Hospital, Beijing, China.
⁴ Department of Radiology, China-Japan Friendship Hospital, Beijing, China.
⁵ Department of Anesthesiology, Peking University International Hospital, Beijing, China.

Abstract

Background and purpose: Diagnosing cervical artery dissection (CAD) is still a challenge based on the current radiographic criteria. This study aimed to assess the value of three-dimensional high-resolution magnetic resonance imaging (3D HRMRI) in the detection of the signs of CAD and its diagnosis.

Materials and methods: Patients with CAD from January 2016 to January 2021 were recruited from our 3D HRMRI database. The signs of dissection (intramural hematomas, intimal flap, double lumen), length and location of the dissection, thickness of the intramural hematoma, intraluminal thrombus, and percentage of dilation of the outer contour of the dissection on 3D HRMRI were assessed.

Results: Fourteen patients with 16 CADs, including 12 carotid CADs and 4 vertebral CADs, were finally diagnosed in this study. On 3D HRMRI, intramural hematomas were detected in 13/16 (81.3%) lesions with high sensitivity (100%) and high specificity (100%). Intimal flaps were found in 9/16 (56.3%) lesions with moderate sensitivity (64.3%) and high specificity (88.9%). Double lumen signs were observed in 4/16 (25.0%) lesions with high sensitivity (80.0%) and high specificity (100%). In addition, concomitant intraluminal thrombus were detected in 4/16 (25.0%) lesions with high sensitivity (80.0%) and high specificity (100%). The mean length of dissection was (25.1 ± 13.7) mm. The mean thickness of the intramural hematoma was (4.3 ± 2.3) mm. The mean percentage of dilation for the outer contour of the dissection was (151.3 ± 28.6)%.

Conclusion: The 3D HRMRI enables detection of the dissecting signs, such as intramural hematoma, intimal flap, double lumen, and intraluminal thrombus with high sensitivity and specificity, suggesting a useful, and non-invasive tool for definitively diagnosing CAD.

Keywords: cervical artery dissection; double lumen; high resolution magnetic resonance image; intimal flap; intramural hematoma.