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MRI of intracranial vertebral artery dissection: evaluation of intramural haematoma using a black blood, variable-flip-angle 3D turbo spin-echo sequence

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Introduction

We investigated the efficacy of three-dimensional black blood T1-weighted imaging (3D-BB-T1WI) using a variable refocusing flip angle turbo spin-echo sequence in the diagnosis of intracranial vertebral artery dissection (VAD).

Methods

Sixteen consecutive patients diagnosed with intracranial VAD underwent magnetic resonance imaging that included 3D time-of-flight-MRA, axial spin-echo T1-weighted images (SE-T1WI) and oblique coronal 3D-BB-T1WI sequences. The visualization, morphology and extent of intramural haematomas were assessed and compared among the sequences. Results obtained by digital subtraction angiography (DSA), 3D-angiography and/or 3D-CT angiography (CTA) were used as standards of reference.

Results

3D-BB-T1WI revealed intramural haematomas in all cases, whereas SE-T1WI and magnetic resonance angiography (MRA) failed to reveal a haematoma in one case and three cases, respectively. The mean visualization grading score for the intramural haematoma was the highest for 3D-BB-T1WI, and there was a statistically significant difference among the sequences (p < 0.001). At least a portion of the intramural haematoma was distinguishable from the lumen on 3D-BB-T1WI, whereas the haematomas were entirely indistinguishable from intraluminal signals on MRA in two cases (12.5 %) and on SE-T1WI in one case (6.3 %). 3D-BB-T1WI revealed the characteristic crescent shape of the intramural haematoma in 14 cases (87.5 %), whereas SE-T1WI and MRA revealed a crescent shape in only 7 cases (43.8 %) and 8 cases (50 %), respectively. In a consensus reading, 3D-BB-T1WI was considered the most consistent sequence in representing the extent and morphology of the lesion in 14 cases (87.5 %), compared to DSA and CTA.

Conclusion

3D-BB-T1WI is a promising method to evaluate intramural haematoma in patients with suspected intracranial VAD.

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We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka-shi, Fukuoka, 814-0180, Japan

    Koichi Takano, Shinnichi Yamashita, Yasuo Kuwabara & Kengo Yoshimitsu

  2. Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan

    Koichiro Takemoto & Tooru Inoue

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  1. Koichi Takano
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  2. Shinnichi Yamashita
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  3. Koichiro Takemoto
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  4. Tooru Inoue
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  5. Yasuo Kuwabara
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  6. Kengo Yoshimitsu
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Correspondence to Koichi Takano.

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Takano, K., Yamashita, S., Takemoto, K. et al. MRI of intracranial vertebral artery dissection: evaluation of intramural haematoma using a black blood, variable-flip-angle 3D turbo spin-echo sequence. Neuroradiology 55, 845–851 (2013). https://doi.org/10.1007/s00234-013-1183-4

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  • DOI: https://doi.org/10.1007/s00234-013-1183-4

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