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

Abstract

Objectives

To evaluate the feasibility of high-resolution MRI (HR-MRI) for diagnosing intracranial vertebrobasilar artery dissection (VBD) and to identify the most useful imaging findings suggesting dissection.

Methods

We retrospectively reviewed 50 patients with suspected intracranial VBDs who underwent HR-MRI. Two neuroradiologists independently reviewed the HR-MR images. The diagnosis based on HR-MRI was compared with the final diagnosis by consensus among the neuroradiologists, neurointerventionist, and neurologist. Two neuroradiologists also sought signs of dissection (mural hematoma, dissection flap, outer-diameter enlargement on T2WI of steno-occlusive lesions). Inter- and intraobserver agreements were analysed.

Results

HR-MRI corroborated the final diagnosis in 47 (94 %; 31 VBD and 16 non-VBD) patients. A mural haematoma was best detected on T1WI and contrast-enhanced (CE)-T1WI (54.3 %). Dissection flaps were observed in almost all cases on CE-T1WI (91.4 %), and then were detected on T2WI (68.6 %). Outer-diameter enlargement of the steno-occlusive lesions on angiography was detected in more than half of the cases (62.9 %). The two reviewers showed almost perfect agreement for the diagnosis of VBD and detecting dissection signs on every sequence.

Conclusions

HR-MRI can be a useful and non-invasive diagnostic tool for intracranial VBD, and dissection flaps on CE-T1WI are the signs with the greatest diagnostic value.

Key Points

• 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.

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Abbreviations

VBD:

Vertebrobasilar artery dissection

HR-MRI:

High-resolution MRI

DSA:

Digital subtraction angiography

CTA:

CT angiography

MRA:

MR angiography

PDWI:

Proton density weighted image

VA:

Vertebral artery

PICA:

Posterior inferior cerebellar artery

SI:

Signal intensity

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Acknowledgements

The scientific guarantor of this publication is Sun Yong Kim. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, observational, performed at one institution.

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Correspondence to Jin Wook Choi.

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Han, M., Rim, NJ., Lee, J.S. et al. Feasibility of high-resolution MR imaging for the diagnosis of intracranial vertebrobasilar artery dissection. Eur Radiol 24, 3017–3024 (2014). https://doi.org/10.1007/s00330-014-3296-5

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  • DOI: https://doi.org/10.1007/s00330-014-3296-5

Keywords

  • Vertebrobasilar artery
  • Dissection
  • Stroke
  • Magnetic resonance imaging
  • High-resolution MR