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Published in: Acta Neurochirurgica 3/2014

01-03-2014 | Clinical Article - Vascular

Imaging investigation of intracranial arterial dissecting aneurysms by using 3 T high-resolution MRI and DSA: from the interventional neuroradiologists’ view

Authors: Yanmin Wang, Xin Lou, Youxiang Li, Binbin Sui, Shengjun Sun, Chuanhui Li, Peng Jiang, Adnan Siddiqui, Xinjian Yang

Published in: Acta Neurochirurgica | Issue 3/2014

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Abstract

Objectives

The purpose of this study was to investigate vessel wall imaging features combined with the luminal shapes of intracranial dissecting aneurysms (IDAs) by using 3 Tesla (3T) high-resolution magnetic resonance imaging (MRI) and digital subtraction angiography (DSA).

Methods

Sixty-seven patients with 76 IDAs were consecutively enrolled in the study from December 2011 to May 2013. DSA was performed to diagnose an IDA and to categorize its angiography patterns into either aneurysmal dilation, steno-occlusive, combined, or unclassifiable. Images of 3T high-resolution MRI were used to evaluate arterial wall imaging features of each lesion. Chi-squared tests were used for statistical analyses.

Results

Aneurysmal dilation (51 of 76, [67 %]) was the most common angiography pattern of IDAs, followed by the combined pattern (20 of 76, [26 %]). Seven percent (five of 76) of IDAs showed steno-occlusive (n = 3) and unclassifiable (n = 2) angiography patterns, in which intramural hematomas were detected in the arterial wall without luminal connection. Intimal flaps (32 of 76, [42 %]), double-lumen sign (38 of 76, [50 %]) and intramural hematomas (46 of 76, [61 %]) were recognized as the characteristic features of dissection by high-resolution MRI. Intramural hematomas occurred more frequently in the combined patterns group (16 of 20, [80 %]) than in the aneurysmal dilation group (25 of 51, [49 %]) (P = .017), while the occurrence of intimal flaps and double-lumen sign did not differ between angiographic patterns (P > .05).

Conclusions

3T high-resolution MRI combined with DSA offered clear visualization of vessel wall features and accurate assessment of the vessel lumen in IDAs. This combined approach would be highly useful for understanding the underlying pathological status of IDAs and in guiding treatment choices.
Literature
1.
go back to reference Ahn SS, Kim BM, Suh SH, Kim DJ, Kim DI, Shin YS, Ha SY, Kwon YS (2012) Spontaneous symptomatic intracranial vertebrobasilar dissection: initial and follow-up imaging findings. Radiology 264:196–202PubMedCrossRef Ahn SS, Kim BM, Suh SH, Kim DJ, Kim DI, Shin YS, Ha SY, Kwon YS (2012) Spontaneous symptomatic intracranial vertebrobasilar dissection: initial and follow-up imaging findings. Radiology 264:196–202PubMedCrossRef
2.
go back to reference Bachmann R, Nassenstein I, Kooijman H, Dittrich R, Kugel H, Niederstadt T, Kuhlenbaumer G, Ringelstein EB, Kramer S, Heindel W (2006) Spontaneous acute dissection of the internal carotid artery: high-resolution magnetic resonance imaging at 3.0 Tesla with a dedicated surface coil. Invest Radiol 41:105–111PubMedCrossRef Bachmann R, Nassenstein I, Kooijman H, Dittrich R, Kugel H, Niederstadt T, Kuhlenbaumer G, Ringelstein EB, Kramer S, Heindel W (2006) Spontaneous acute dissection of the internal carotid artery: high-resolution magnetic resonance imaging at 3.0 Tesla with a dedicated surface coil. Invest Radiol 41:105–111PubMedCrossRef
3.
go back to reference Bachmann R, Nassenstein I, Kooijman H, Dittrich R, Stehling C, Kugel H, Niederstadt T, Kuhlenbaumer G, Ringelstein EB, Kramer S, Heindel W (2007) High-resolution magnetic resonance imaging (MRI) at 3.0 Tesla in the short-term follow-up of patients with proven cervical artery dissection. Invest Radiol 42:460–466PubMedCrossRef Bachmann R, Nassenstein I, Kooijman H, Dittrich R, Stehling C, Kugel H, Niederstadt T, Kuhlenbaumer G, Ringelstein EB, Kramer S, Heindel W (2007) High-resolution magnetic resonance imaging (MRI) at 3.0 Tesla in the short-term follow-up of patients with proven cervical artery dissection. Invest Radiol 42:460–466PubMedCrossRef
4.
go back to reference Endo S, Nishijima M, Nomura H, Takaku A, Okada E (1993) A pathological study of intracranial posterior circulation dissecting aneurysms with subarachnoid hemorrhage: report of three autopsied cases and review of the literature. Neurosurgery 33:732–738PubMedCrossRef Endo S, Nishijima M, Nomura H, Takaku A, Okada E (1993) A pathological study of intracranial posterior circulation dissecting aneurysms with subarachnoid hemorrhage: report of three autopsied cases and review of the literature. Neurosurgery 33:732–738PubMedCrossRef
5.
go back to reference Fatima Z, Motosugi U, Okumura A, Ishigame K, Araki T (2012) Basi-parallel anatomical scanning (BPAS)-MRI can improve discrimination of vertebral artery dissection from atherosclerosis and hypoplasia. Acad radiol 19:1362–1367PubMedCrossRef Fatima Z, Motosugi U, Okumura A, Ishigame K, Araki T (2012) Basi-parallel anatomical scanning (BPAS)-MRI can improve discrimination of vertebral artery dissection from atherosclerosis and hypoplasia. Acad radiol 19:1362–1367PubMedCrossRef
6.
go back to reference Habs M, Pfefferkorn T, Cyran CC, Grimm J, Rominger A, Hacker M, Opherk C, Reiser MF, Nikolaou K, Saam T (2011) Age determination of vessel wall hematoma in spontaneous cervical artery dissection: a multi-sequence 3 T cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. doi:10.1186/1532-429X-13-76 PubMed Habs M, Pfefferkorn T, Cyran CC, Grimm J, Rominger A, Hacker M, Opherk C, Reiser MF, Nikolaou K, Saam T (2011) Age determination of vessel wall hematoma in spontaneous cervical artery dissection: a multi-sequence 3 T cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. doi:10.​1186/​1532-429X-13-76 PubMed
7.
go back to reference Horie N, Morikawa M, Fukuda S, Hayashi K, Suyama K, Nagata I (2011) Detection of blood blister-like aneurysm and intramural hematoma with high-resolution magnetic resonance imaging. J Neurosurg 115:1206–1209PubMedCrossRef Horie N, Morikawa M, Fukuda S, Hayashi K, Suyama K, Nagata I (2011) Detection of blood blister-like aneurysm and intramural hematoma with high-resolution magnetic resonance imaging. J Neurosurg 115:1206–1209PubMedCrossRef
8.
go back to reference Hosoya T, Adachi M, Yamaguchi K, Haku T, Kayama T, Kato T (1999) Clinical and neuroradiological features of intracranial vertebrobasilar artery dissection. Stroke 30:1083–1090PubMedCrossRef Hosoya T, Adachi M, Yamaguchi K, Haku T, Kayama T, Kato T (1999) Clinical and neuroradiological features of intracranial vertebrobasilar artery dissection. Stroke 30:1083–1090PubMedCrossRef
9.
go back to reference Hunter MA, Santosh C, Teasdale E, Forbes KP (2012) High-resolution double inversion recovery black-blood imaging of cervical artery dissection using 3 T MR imaging. AJNR 33:E133–E137PubMedCrossRef Hunter MA, Santosh C, Teasdale E, Forbes KP (2012) High-resolution double inversion recovery black-blood imaging of cervical artery dissection using 3 T MR imaging. AJNR 33:E133–E137PubMedCrossRef
10.
go back to reference Igase K, Matsubara I, Igase M, Miyazaki H, Sadamoto K (2012) Initial experience in evaluating the prevalence of unruptured intracranial aneurysms detected on 3-tesla MRI. Cerebrovasc Dis 33:348–353PubMedCrossRef Igase K, Matsubara I, Igase M, Miyazaki H, Sadamoto K (2012) Initial experience in evaluating the prevalence of unruptured intracranial aneurysms detected on 3-tesla MRI. Cerebrovasc Dis 33:348–353PubMedCrossRef
11.
go back to reference Ishihara T, Izawa N, Kawakami T, Kokubun N, Hirata K, Sato T (2002) Early diagnosis of vertebral dissecting aneurysm: a magnetic resonance angiography study. Intern Med 41:1193–1195PubMedCrossRef Ishihara T, Izawa N, Kawakami T, Kokubun N, Hirata K, Sato T (2002) Early diagnosis of vertebral dissecting aneurysm: a magnetic resonance angiography study. Intern Med 41:1193–1195PubMedCrossRef
12.
go back to reference Kitanaka C, Tanaka J, Kuwahara M, Teraoka A (1994) Magnetic resonance imaging study of intracranial vertebrobasilar artery dissections. Stroke 25:571–575PubMedCrossRef Kitanaka C, Tanaka J, Kuwahara M, Teraoka A (1994) Magnetic resonance imaging study of intracranial vertebrobasilar artery dissections. Stroke 25:571–575PubMedCrossRef
13.
go back to reference Kocaeli H, Chaalala C, Andaluz N, Zuccarello M (2009) Spontaneous intradural vertebral artery dissection: a single-center experience and review of the literature. Skull Base 19:209–218PubMedCentralPubMedCrossRef Kocaeli H, Chaalala C, Andaluz N, Zuccarello M (2009) Spontaneous intradural vertebral artery dissection: a single-center experience and review of the literature. Skull Base 19:209–218PubMedCentralPubMedCrossRef
14.
15.
go back to reference Kwak JH, Choi JW, Park HJ, Chae EY, Park ES, Lee DH, Suh DC (2011) Cerebral artery dissection: spectrum of clinical presentations related to angiographic findings. Neurointervention 6:78–83PubMedCentralPubMedCrossRef Kwak JH, Choi JW, Park HJ, Chae EY, Park ES, Lee DH, Suh DC (2011) Cerebral artery dissection: spectrum of clinical presentations related to angiographic findings. Neurointervention 6:78–83PubMedCentralPubMedCrossRef
16.
go back to reference Lanzino G, Kaptain G, Kallmes DF, Dix JE, Kassell NF (1997) Intracranial dissecting aneurysm causing subarachnoid hemorrhage: the role of computerized tomographic angiography and magnetic resonance angiography. Surg Neurol 48:477–481PubMedCrossRef Lanzino G, Kaptain G, Kallmes DF, Dix JE, Kassell NF (1997) Intracranial dissecting aneurysm causing subarachnoid hemorrhage: the role of computerized tomographic angiography and magnetic resonance angiography. Surg Neurol 48:477–481PubMedCrossRef
17.
go back to reference Lee HO, Kwak HS, Chung GH, Hwang SB (2011) Diagnostic usefulness of high resolution cross sectional MRI in symptomatic middle cerabral arterial dissection. J Korean Neurosurg Soc 49:370–372PubMedCentralPubMedCrossRef Lee HO, Kwak HS, Chung GH, Hwang SB (2011) Diagnostic usefulness of high resolution cross sectional MRI in symptomatic middle cerabral arterial dissection. J Korean Neurosurg Soc 49:370–372PubMedCentralPubMedCrossRef
18.
go back to reference Matouk CC, Mandell DM, Gunel M, Bulsara KR, Malhotra A, Hebert R, Johnson MH, Mikulis DJ, Minja FJ (2013) Vessel wall magnetic resonance imaging identifies the site of rupture in patients with multiple intracranial aneurysms: proof of principle. Neurosurgery 72:492–496PubMedCrossRef Matouk CC, Mandell DM, Gunel M, Bulsara KR, Malhotra A, Hebert R, Johnson MH, Mikulis DJ, Minja FJ (2013) Vessel wall magnetic resonance imaging identifies the site of rupture in patients with multiple intracranial aneurysms: proof of principle. Neurosurgery 72:492–496PubMedCrossRef
19.
go back to reference Mizutani T (1996) A fatal, chronically growing basilar artery: a new type of dissecting aneurysm. J Neurosurg 84:962–971PubMedCrossRef Mizutani T (1996) A fatal, chronically growing basilar artery: a new type of dissecting aneurysm. J Neurosurg 84:962–971PubMedCrossRef
20.
21.
go back to reference Mizutani T, Aruga T, Kirino T, Miki Y, Saito I, Tsuchida T (1995) Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36:905–911, discussion 912–913PubMedCrossRef Mizutani T, Aruga T, Kirino T, Miki Y, Saito I, Tsuchida T (1995) Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36:905–911, discussion 912–913PubMedCrossRef
22.
go back to reference Mizutani T, Kojima H, Asamoto S (2004) Healing process for cerebral dissecting aneurysms presenting with subarachnoid hemorrhage. Neurosurgery 54:342–347, discussion 347–348PubMedCrossRef Mizutani T, Kojima H, Asamoto S (2004) Healing process for cerebral dissecting aneurysms presenting with subarachnoid hemorrhage. Neurosurgery 54:342–347, discussion 347–348PubMedCrossRef
23.
go back to reference Mizutani T, Miki Y, Kojima H, Suzuki H (1999) Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms. Neurosurgery 45:253–259PubMedCrossRef Mizutani T, Miki Y, Kojima H, Suzuki H (1999) Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms. Neurosurgery 45:253–259PubMedCrossRef
24.
go back to reference Naggara O, Louillet F, Touze E, Roy D, Leclerc X, Mas JL, Pruvo JP, Meder JF, Oppenheim C (2010) Added value of high-resolution MR imaging in the diagnosis of vertebral artery dissection. AJNR 31:1707–1712PubMedCrossRef Naggara O, Louillet F, Touze E, Roy D, Leclerc X, Mas JL, Pruvo JP, Meder JF, Oppenheim C (2010) Added value of high-resolution MR imaging in the diagnosis of vertebral artery dissection. AJNR 31:1707–1712PubMedCrossRef
25.
go back to reference Naggara O, Oppenheim C, Toussaint JF, Calvet D, Touze E, Mas JL, Meder JF (2007) Asymptomatic spontaneous acute vertebral artery dissection: diagnosis by high-resolution magnetic resonance images with a dedicated surface coil. Eur Radiol 17:2434–2435PubMedCrossRef Naggara O, Oppenheim C, Toussaint JF, Calvet D, Touze E, Mas JL, Meder JF (2007) Asymptomatic spontaneous acute vertebral artery dissection: diagnosis by high-resolution magnetic resonance images with a dedicated surface coil. Eur Radiol 17:2434–2435PubMedCrossRef
26.
go back to reference Nakagawa K, Touho H, Morisako T, Osaka Y, Tatsuzawa K, Nakae H, Owada K, Matsuda K, Karasawa J (2000) Long-term follow-up study of unruptured vertebral artery dissection: clinical outcomes and serial angiographic findings. J Neurosurg 93:19–25PubMedCrossRef Nakagawa K, Touho H, Morisako T, Osaka Y, Tatsuzawa K, Nakae H, Owada K, Matsuda K, Karasawa J (2000) Long-term follow-up study of unruptured vertebral artery dissection: clinical outcomes and serial angiographic findings. J Neurosurg 93:19–25PubMedCrossRef
27.
go back to reference Nakatomi H, Segawa H, Kurata A, Shiokawa Y, Nagata K, Kamiyama H, Ueki K, Kirino T (2000) Clinicopathological study of intracranial fusiform and dolichoectatic aneurysms: insight on the mechanism of growth. Stroke 31:896–900PubMedCrossRef Nakatomi H, Segawa H, Kurata A, Shiokawa Y, Nagata K, Kamiyama H, Ueki K, Kirino T (2000) Clinicopathological study of intracranial fusiform and dolichoectatic aneurysms: insight on the mechanism of growth. Stroke 31:896–900PubMedCrossRef
28.
go back to reference Ono H, Nakatomi H, Tsutsumi K, Inoue T, Teraoka A, Yoshimoto Y, Ide T, Kitanaka C, Ueki K, Imai H, Saito N (2013) Symptomatic recurrence of intracranial arterial dissections: follow-up study of 143 consecutive cases and pathological investigation. Stroke 44:126–131PubMedCrossRef Ono H, Nakatomi H, Tsutsumi K, Inoue T, Teraoka A, Yoshimoto Y, Ide T, Kitanaka C, Ueki K, Imai H, Saito N (2013) Symptomatic recurrence of intracranial arterial dissections: follow-up study of 143 consecutive cases and pathological investigation. Stroke 44:126–131PubMedCrossRef
29.
go back to reference Roccatagliata L, Guedin P, Condette-Auliac S, Gaillard S, Colas F, Boulin A, Wang A, Guieu S, Rodesch G (2010) Partially thrombosed intracranial aneurysms: symptoms, evolution, and therapeutic management. Acta Neurochir 152:2133–2142PubMedCrossRef Roccatagliata L, Guedin P, Condette-Auliac S, Gaillard S, Colas F, Boulin A, Wang A, Guieu S, Rodesch G (2010) Partially thrombosed intracranial aneurysms: symptoms, evolution, and therapeutic management. Acta Neurochir 152:2133–2142PubMedCrossRef
30.
go back to reference Swartz RH, Bhuta SS, Farb RI, Agid R, Willinsky RA, Terbrugge KG, Butany J, Wasserman BA, Johnstone DM, Silver FL, Mikulis DJ (2009) Intracranial arterial wall imaging using high-resolution 3-tesla contrast-enhanced MRI. Neurology 72:627–634PubMedCrossRef Swartz RH, Bhuta SS, Farb RI, Agid R, Willinsky RA, Terbrugge KG, Butany J, Wasserman BA, Johnstone DM, Silver FL, Mikulis DJ (2009) Intracranial arterial wall imaging using high-resolution 3-tesla contrast-enhanced MRI. Neurology 72:627–634PubMedCrossRef
31.
go back to reference Yoshimoto Y, Wakai S (1997) Unruptured intracranial vertebral artery dissection. Clinical course and serial radiographic imagings. Stroke 28:370–374PubMedCrossRef Yoshimoto Y, Wakai S (1997) Unruptured intracranial vertebral artery dissection. Clinical course and serial radiographic imagings. Stroke 28:370–374PubMedCrossRef
Metadata
Title
Imaging investigation of intracranial arterial dissecting aneurysms by using 3 T high-resolution MRI and DSA: from the interventional neuroradiologists’ view
Authors
Yanmin Wang
Xin Lou
Youxiang Li
Binbin Sui
Shengjun Sun
Chuanhui Li
Peng Jiang
Adnan Siddiqui
Xinjian Yang
Publication date
01-03-2014
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 3/2014
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-013-1989-1

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