Jung Seung Chai, Kim Ho Sung, Choi Choong-Gon, Kim Sang Joon, Kwon Sun U, Kang Dong-Wha, Kim Jong S
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, 138-736, Seoul, Songpa-Gu, Republic of Korea.
Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Clin Neuroradiol. 2018 Jun;28(2):171-181. doi: 10.1007/s00062-016-0544-x. Epub 2016 Sep 27.
The aim of this article is to present high-resolution magnetic resonance imaging (HR-MRI) findings of chronic stage spontaneous and unruptured intracranial artery dissection (ICAD).
From March 2012 to April 2016 a total of 29 patients (15 male and14 female, age range 37-68 years) with chronic stage spontaneous and unruptured ICAD (vertebral artery 27, posterior inferior cerebellar artery 1 and middle cerebral artery 1) were retrospectively enrolled. Patients underwent HR-MRI more than 2 months (median interval 564 days, range 69-391 days) after symptom onset and were diagnosed at symptom onset or at the first imaging acquisition, which included luminal angiography and/or HR-MRI with clinical information. The HR-MRI findings were evaluated against those of luminal angiography on the basis of the lumen wall morphology, including thickening, contrast enhancement and residual dissection.
The HR-MRI findings were classified into complete normalization (normal lumen and wall with or without mild enhancement, n = 6), complete normalization with minimal wall changes (focal wall thickening with enhancement but normal luminal angiography, n = 8), incomplete normalization (focal wall thickening with enhancement with dilatation and stenosis on luminal angiography, n = 4), dissecting aneurysm (fusiform aneurysm with residual dissection findings, n = 8) and occlusion (small outer arterial diameter with diffuse contrast enhancement, n = 3).
The use of HR-MRI can demonstrate the distinguishing morphological features of chronic stage of spontaneous and unruptured ICAD as complete normalization, complete normalization with minimal wall changes, incomplete normalization, dissecting aneurysm and occlusion.
本文旨在呈现慢性期自发性未破裂颅内动脉夹层（ICAD）的高分辨率磁共振成像（HR-MRI）结果。
回顾性纳入2012年3月至2016年4月期间共29例慢性期自发性未破裂ICAD患者（男性15例，女性14例，年龄范围37 - 68岁），其中椎动脉27例，小脑后下动脉1例，大脑中动脉1例。患者在症状发作2个月后接受HR-MRI检查（中位间隔564天，范围69 - 391天），在症状发作时或首次影像学检查时被诊断，检查包括管腔血管造影和/或HR-MRI以及临床信息。根据管腔壁形态，包括增厚、对比增强和残余夹层，将HR-MRI结果与管腔血管造影结果进行比较评估。
HR-MRI结果分为完全正常化（管腔和管壁正常，有或无轻度增强，n = 6）、有最小管壁改变的完全正常化（局灶性管壁增厚伴增强但管腔血管造影正常，n = 8）、不完全正常化（局灶性管壁增厚伴增强，管腔血管造影有扩张和狭窄，n = 4）、夹层动脉瘤（梭形动脉瘤伴残余夹层表现，n = 8）和闭塞（动脉外径小伴弥漫性对比增强，n = 3）。
HR-MRI的应用能够显示慢性期自发性未破裂ICAD的不同形态特征，如完全正常化、有最小管壁改变的完全正常化、不完全正常化、夹层动脉瘤和闭塞。
