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

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 sCADreceived 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 etal. Clinical Significance of Intraluminal Contrast Enhancement in Patients with Spontaneous Cervical Artery Dissection: A Black-Blood MRI Study. Fortschr Röntgenstr 2017; 189: 624-631.