Clinical Significance of Intraluminal Contrast Enhancement in Patients with Spontaneous Cervical Artery Dissection: A Black-Blood MRI Study

 

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Abstract

Purpose Recent studies have suggested that intraluminal thrombi show contrast enhancement on carotid black-blood T1w MRI. The aim of this study was to evaluate the significance of intraluminal contrast enhancement (iCE) regarding symptom status in patients with spontaneous cervical artery dissection (sCAD).

Methods 33 consecutive patients (19 men) with sCAD received a brain MRI (DIFF, T2w, T2*w, FLAIR) and a multi-sequence 3T-MRI with fat-saturated high-resolution black-blood T1w-sequences pre- and post-contrast, contrast-enhanced MR angiography and TOF images of carotid and vertebral arteries. Presence/absence of iCE, vessel occlusion and vessel wall hematoma (hyperintense in T1w pre-contrast) were analysed by two radiologists in consensus decision.

Results 44 of 132 analysed vessels had a vessel wall hematoma, consistent with sCAD. In 17 of 44 dissected vessels an acute ischemic stroke was found. 16 of 17 (94.1 %) vessels ipsilateral to ischemic stroke demonstrated iCE, compared to 9 of 44 (20.4 %) dissected vessels without stroke (P< 0.001). The presence/absence of iCE resulted in a sensitivity, specificity, positive and negative predictive value and accuracy for ischemic stroke of 0.94, 0.67, 0.64, 0.95, and 0.77, respectively, and an odds ratio of 32.0.

Conclusion iCE, which is suggestive of intraluminal thrombus formation, is strongly correlated with ischemic symptoms in patients with sCAD.

Key points 

• Intraluminal contrast enhancement is associated with cerebral ischemia in corresponding vessel territories in patients with cervical artery dissection.

• Our results suggest that intraluminal contrast enhancement represents intraluminal thrombus formation.

• Black-blood imaging might be useful to identify those patients with cervical artery dissection at higher risk for initial or recurrent stroke.

Citation Format

• Coppenrath E, Lenz O, Sommer N et al. Clinical Significance of Intraluminal Contrast Enhancement in Patients with Spontaneous Cervical Artery Dissection: A Black-Blood MRI Study. Fortschr Röntgenstr 2017; 189: 624 – 631

Zusammenfassung

Ziel Kürzlich durchgeführte Studien zeigten, dass intraluminale Thromben der A. carotis interna in black-blood (BB)-MR-Sequenzen eine Kontrastmittelaufnahme zeigen. Ziel der Studie ist es, die Wertigkeit der intraluminalen Kontrastmittelaufnahme bei Patienten mit einer spontanen arteriellen Dissektion der Halsgefäße zu untersuchen.

Material und Methoden 33 Patienten mit spontaner arterieller Dissektion der Halsgefäße (sCAD) erhielten ein MRT des Kopfes (Diffusion, T2w, T2*w, FLAIR) und eine 3T-MRT- Untersuchung der Halsgefäße mit hochaufgelösten fettgesättigten BB Sequenzen vor und nach Kontrastmittelgabe, sowie einer TOF-Sequenz. Nachweis oder Abwesenheit einer intraluminalen Kontrastmittelaufnahme (iCE), eines Gefäßverschlusses und eines Gefäßwandhämatoms (hyperintenses Signal in T1w vor Kontrastmittelgabe) wurden von zwei Radiologen im Konsensus untersucht.

Ergebnisse In 44 von 132 bewerteten Gefäßen wurde ein Gefäßwandhämatom gefunden, vereinbar mit einer sCAD. Bei 17 von 44 disseziierten Gefäßen wurde in der Hirn-MRT ein akuter Schlaganfall auf derselben Seite diagnostiziert. 16 von 17 (94,1 %) dieser Gefäße ipsilateral des Schlaganfalls zeigten ein iCE, verglichen mit 9 von 44 (20,4 %) disseziierten Gefäßen ohne Nachweis eines Schlaganfall (p < 0,001). Die Auswertung (Nachweises oder Abwesenheit von iCE) ergab eine Sensitivität, eine Spezifität, einen positiven bzw. negativen prädiktiven Wert sowie eine Accuracy von 0,94; 0,67, 0,64 und 0,95 und 0,77, sowie eine Odds ratio von 32,0.

Schlussfolgerung iCE scheint eine intraluminale Thrombosierung anzuzeigen, die streng korreliert ist mit ischämischen Symptomen bei Patienten mit einer sCAD.

Kernaussagen 

• Bei Patienten mit arterieller Dissektion der Halsgefäße korreliert die intraluminale Kontrastmittelaufnahme mit einer umschriebenen Hirn-Ischämie im entsprechenden Gefäßterritorium.

• Unsere Ergebnisse suggerieren, dass die intraluminale Kontrastmittelaufnahme eine intraluminale Thrombusbildung widerspiegelt.

• Die Untersuchung von Dissektionspatienten mittels black-blood-Sequenzen könnte dazu beitragen, Patienten mit einem hohen Schlaganfallrisiko zu erkennen.

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