Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakitaku, 731 0293 Hiroshima, Japan.
Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakitaku, 731 0293 Hiroshima, Japan; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105006. doi: 10.1016/j.jstrokecerebrovasdis.2020.105006. Epub 2020 Jun 16.
The mechanism involved in progression of unruptured intracranial artery dissection (IAD) is poorly understood. We investigated the relationship between contrast enhancement of dissecting lesions on magnetic resonance vessel wall imaging (MR-VWI) and unruptured IAD progression on the hypothesis that this finding might predict its instability.
A total of 49 unruptured IADs were investigated retrospectively. Three-dimensional T1-weighted fast spin-echo sequences were obtained before and after injection of contrast medium, and the dissecting lesion/pituitary stalk contrast enhancement ratio (CR) was calculated. Unruptured IAD progression was defined as morphological deterioration; progressive dilatation or stenosis. The relations between unruptured IAD progression and potential risk factors were statistically investigated.
Morphological deterioration was demonstrated in eleven of 49 unruptured IADs (22 %). The CR value and male predominance was significantly higher in progressed IADs than stable ones (1.0 vs. 0.65; p = 0.0035, 82% vs 37%; p= 0.015, respectively). On stepwise multivariable logistic regression analysis, the CR value was independently associated with unruptured IAD progression with odds ratio of 102.5 (95% CI, 2.59-4059, P=0.0013). The optimal cutoff value of CR to estimate IADs with progression was 0.87 (sensitivity, 0.82; specificity, 0.74). Multimodalic images showed contrast enhancement on VWI corresponded to residual stagnant flow in dissecting lesions.
Quantitative analysis of contrast enhancement on VWI could predict instability of unruptured IADs. Contrast enhancement in dissecting lesions would be a clue to understand the mechanism of unruptured IAD progression.
颅内未破裂动脉夹层（IAD）进展的机制尚不清楚。我们研究了磁共振管壁成像（MR-VWI）上夹层病变的对比增强与未破裂 IAD 进展之间的关系，假设这种发现可能预测其不稳定性。
回顾性研究了 49 例未破裂 IAD。在注射造影剂前后获得三维 T1 加权快速自旋回波序列，并计算夹层病变/垂体柄对比增强比（CR）。未破裂 IAD 进展定义为形态恶化；进行性扩张或狭窄。统计分析未破裂 IAD 进展与潜在危险因素之间的关系。
在 49 例未破裂 IAD 中，有 11 例（22%）出现形态恶化。进展性 IAD 的 CR 值和男性优势明显高于稳定性 IAD（1.0 比 0.65；p=0.0035，82%比 37%；p=0.015）。逐步多变量逻辑回归分析显示，CR 值与未破裂 IAD 进展独立相关，优势比为 102.5（95%CI，2.59-4059，P=0.0013）。估计 IAD 进展的 CR 值最佳截断值为 0.87（敏感性，0.82；特异性，0.74）。多模态图像显示 VWI 上的对比增强与夹层病变中残留的停滞血流相对应。
VWI 上对比增强的定量分析可预测未破裂 IAD 的不稳定性。夹层病变中的对比增强可能是理解未破裂 IAD 进展机制的线索。
