Evaluation Of High-resolution Magnetic Resonance Imaging For The Diagnosis Of Intracranial Artery Dissection

PurposeTo investigate the feasibility of high-resolution MRI(HR-MRI)for diagnosing intracranial artery dissection(IAD),and to identify the most useful imaging findings for improving the diagnosis rates.Materials and MethodsWe recruited the clinically suspicious patients with IAD as participants in our research.All participants underwent the HR-MRI and DSA examination.We retrospectively reviewed the clinical data and images of 43 patients with suspected intracranial arterial dissection.Two experienced radiologists independently reviewed the HR-MR images and the DSA images.We compared the diagnosis results between the HR-MRI and DSA examination.Two radiologists searched for the marks in diagnosing the dissection(such as mural hematoma and dissection flap),and determined the most characteristic diagnosis symptom.Consistency analysis was calculated between the results from two radiologists.Results1.The consistency analysis about the diagnosis by two radiologists suggests that Kappa value=0.88 and P<0.001.2.With the HR-MRI examination,thirty-two IAD and eleven non-IAD patients were diagnosed.Thirty-four IAD and nine non-IAD were finally clinically diagnosed by DSA.Regarded the DSA as the gold standard,the sensitivity of HR-MRI in IAD was 91.2%,and the specificity was 88.9%.The positive predictive value was 96.9%,and the negative predictive value was 72.7%.The area under the ROC curve is 0.90,P < 0.90.The results indicate that two examination methods showed good consistency.3.Among thirty-four patients with dissection,the incidence of dissection in the vertebral artery(73.5%)was higher than basilar artery(20.6%)and the middle cerebral artery(5.9%).Among twenty-five patients with vertebral artery dissection,the incidence of dissection distal to PICA(72%)was superior than proximal(28%).4.A mural haematoma was detected obviously on T1WI(52.9%)and CE-T1WI(52.9%).Dissection flaps and double lumen sign were observed in almost all cases on CE-T1WI(94.1 %).The two reviewers showed almost perfect agreement for the diagnosis of IAD and detecting dissection signs on every sequence.Conclusions1.HR-MRI has excellent soft tissue contrast and spatial resolution.It is a non-invasive technique in intracranial arterial wall imaging.It plays an important role in the diagnosis,differential diagnosis and follow-up of IAD.2.HR-MRI can clearly show the intramural hematoma,intimal flap and double lumen changes in blood vessels.CE-T1 WI can be regarded as an indicator in detecting the dissection flaps.