Age determination of vessel wall hematoma in spontaneous cervical artery dissection: A multi-sequence 3T Cardiovascular
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RESEARCH
Open Access
Age determination of vessel wall hematoma in spontaneous cervical artery dissection: A multi-sequence 3T Cardiovascular Magnetic resonance study Maximilian Habs1, Thomas Pfefferkorn2, Clemens C Cyran1, Jochen Grimm1, Axel Rominger3, Marcus Hacker3, Christian Opherk2, Maximilian F Reiser1, Konstantin Nikolaou1 and Tobias Saam1*
Abstract Background: Previously proposed classifications for carotid plaque and cerebral parenchymal hemorrhages are used to estimate the age of hematoma according to its signal intensities on T1w and T2w MR images. Using these classifications, we systematically investigated the value of cardiovascular magnetic resonance (CMR) in determining the age of vessel wall hematoma (VWH) in patients with spontaneous cervical artery dissection (sCAD). Methods: 35 consecutive patients (mean age 43.6 ± 9.8 years) with sCAD received a cervical multi-sequence 3T CMR with fat-saturated black-blood T1w-, T2w- and TOF images. Age of sCAD was defined as time between onset of symptoms (stroke, TIA or Horner’s syndrome) and the CMR scan. VWH were categorized into hyperacute, acute, early subacute, late subacute and chronic based on their signal intensities on T1w- and T2w images. Results: The mean age of sCAD was 2.0, 5.8, 15.7 and 58.7 days in patients with acute, early subacute, late subacute and chronic VWH as classified by CMR (p < 0.001 for trend). Agreement was moderate between VWH types in our study and the previously proposed time scheme of signal evolution for cerebral hemorrhage, Cohen’s kappa 0.43 (p < 0.001). There was a strong agreement of CMR VWH classification compared to the time scheme which was proposed for carotid intraplaque hematomas with Cohen’s kappa of 0.74 (p < 0.001). Conclusions: Signal intensities of VWH in sCAD vary over time and multi-sequence CMR can help to determine the age of an arterial dissection. Furthermore, findings of this study suggest that the time course of carotid hematomas differs from that of cerebral hematomas. Keywords: CMR, internal carotid artery dissection, vertebral artery dissection, hematoma, stroke
Background Spontaneous cervical artery dissection (sCAD) is an increasingly recognized cause of ischemic stroke, particularly in younger patients [1]. Timely diagnosis is mandatory, as instant anticoagulation or antithrombotic therapy can help to prevent more serious complications [2]. Clinical symptoms are often nonspecific. Therefore diagnosis may be facilitated by dedicated imaging techniques. Several studies have shown that cardiovascular magnetic * Correspondence: [email protected] 1 Dept. of Clinical Radiology, University of Munich, Grosshadern Campus, Munich, Germany Full list of author information is available at the end of the article
resonance (CMR) is ideally suited to establish the diagnosis of sCAD by identifying the vessel wall hematoma (VWH) using fat suppressed T1-weighted images [3-5]. Due to the nonspecific symptoms of the disease, diagnosis is often delayed and it is often not possible to determine the exa
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