Ishimaru Hideki, Ikebe Yohei, Morikawa Minoru, Ideguchi Reiko, Tateishi Yohei, Tsujino Akira, Uetani Masataka
Department of Radiology, Nagasaki University Hospital, Nagasaki, Japan.
Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan.
Cerebrovasc Dis. 2023;52(1):89-96. doi: 10.1159/000524840. Epub 2022 Jul 6.
We aimed to investigate the clinical significance of the low signal in the intracranial vertebral artery wall observed on susceptibility-weighted angiography.
We retrospectively reviewed susceptibility-weighted angiographies from 200 consecutive patients with acute ischemic stroke in the posterior circulation territory. The presence of eccentric or concentric low signals in the vertebral artery wall was examined and evaluated. The etiology of the low signal was also investigated as much as possible by referring to computed tomography and T1-weighted imaging (T1WI). We also compared its frequency in each stroke subtype.
A low signal was observed in 128/200 patients (64%). The low signals (58%) corresponded to vessel wall calcification in 74 of 128 patients and to vessel wall thickening showing intermediate to low (n = 8) or high (n = 16) signals on T1WI in 24 (19%) patients. The low signal did not have vessel wall thickening or calcification in 1 patient, and the cause of the low signal could not be verified in 29 patients. According to stroke subtypes, a low signal was observed in 14/14 (100%) vertebral artery dissections, all of which corresponded to intramural hematoma. A low signal was observed in 51/65 (78%) atherothromboses, which were significantly more frequent than cardioembolism (34/66; 52%) and small-artery disease (18/39; 46%) (p < 0.01). In atherothrombosis, calcification was the most common cause of low signal (n = 32; 63%).
Low signals on susceptibility-weighted angiography were frequently observed in vertebral artery dissection and atherothrombosis, reflecting intramural hematoma in all of the former and predominantly calcification in the latter.
我们旨在研究在磁敏感加权血管造影上观察到的颅内椎动脉壁低信号的临床意义。
我们回顾性分析了200例后循环区域急性缺血性卒中患者的磁敏感加权血管造影。检查并评估椎动脉壁上偏心或同心低信号的存在情况。还通过参考计算机断层扫描和T1加权成像（T1WI）尽可能地探究低信号的病因。我们还比较了其在每种卒中亚型中的出现频率。
200例患者中有128例（64%）观察到低信号。128例患者中的74例（58%）低信号对应血管壁钙化，24例（19%）患者的低信号对应T1WI上显示中等至低信号（n = 8）或高信号（n = 16）的血管壁增厚。1例患者的低信号没有血管壁增厚或钙化，29例患者的低信号病因无法证实。根据卒中亚型，14例椎动脉夹层中有14例（100%）观察到低信号，所有这些均对应壁内血肿。65例动脉粥样硬化血栓形成中有51例（78%）观察到低信号，其发生率显著高于心源性栓塞（34/66；52%）和小动脉疾病（18/39；46%）（p < 0.01）。在动脉粥样硬化血栓形成中，钙化是低信号最常见的原因（n = 32；63%）。
磁敏感加权血管造影上的低信号在椎动脉夹层和动脉粥样硬化血栓形成中经常观察到，前者反映壁内血肿，后者主要反映钙化。
