Along with stenosis, intramural hematoma (IMH) detection significantly contributed to acute ischemic stroke pathogenesis in patients with suspected cervical artery dissection, a recent study found. In addition, IMH detection can be made more reliable with heavily T1-weighted sequences. Researchers conducted a retrospective study of 227 patients undergoing MRI/magnetic resonance angiography for suspected dissection. Imaging included standard turbo spin–echo (TSE) T1-fat saturation and heavily T1-weighted flow-suppressed magnetization-prepared rapid acquisition gradient–recalled echo sequences. Patients consisted of 41.9% men, mean age of 47.3±16.6 years, with 114 dissections and 107 strokes. They found:
- IMH interrater reliability was significantly higher for magnetization-prepared rapid acquisition gradient–recalled echo vs T1-fat saturation.
- The final acute stroke prediction model included magnetization-prepared rapid acquisition gradient–recalled echo-detected IMH, stenosis, pseudoaneurysm, male sex, current smoking, and nondissection stroke sources.
- The final model had high discrimination for acute stroke, compared with models without stenosis, and without stenosis and IMH.
McNally JS, Hinckley PJ, Sakata A, et al. Magnetic resonance imaging and clinical factors associated with ischemic stroke in patients suspected of cervical artery dissection. [Published online ahead of print September 11, 2018]. Stroke. doi:STROKEAHA.118.021868.