Intracranial artery dissection (IAD) often causes headache and cerebral vascular ischemic events. The imaging characteristics of IAD remain unclear. This study aims to characterize the appearance of culprit and non-culprit IAD using high-resolution cardiovascular magnetic resonance imaging (hrCMR) and quantify the incremental value of hrCMR in identifying higher risk lesions. Imaging data from patients who underwent intervention examination or treatment using digital subtraction angiography (DSA) and hrCMR using a 3 T CMR system within 30 days after the onset of neurological symptoms were collected. The CMR protocol included diffusion-weighted imaging (DWI), black blood T1-, T2- and contrast-enhanced T1-weighted sequences. Lesions were classified as culprit and non-culprit according to imaging findings and patient clinical presentations. Univariate and multivariate analyses were performed to assess the difference between culprit and non-culprit lesions and complementary value of hrCMR in identifying higher risk lesions. In total, 75 patients were included in this study. According to the morphology, lesions could be classified into five types: Type I, classical dissection (n = 50); Type II, fusiform aneurysm (n = 1); Type III, long dissected aneurysm (n = 3); Type IV, dolichoectatic dissecting aneurysm (n = 9) and Type V, saccular aneurysm (n = 12). Regression analyses showed that age and hypertension were both associated with culprit lesions (age: OR, 0.83; 95% CI 0.75–0.92; p < 0.001 and hypertension: OR, 66.62; 95% CI 5.91–751.11; p = 0.001). Hematoma identified by hrCMR was significantly associated with culprit lesions (OR, 16.80; 95% CI 1.01–280.81; p = 0.037). Moreover, 17 cases (16 lesions were judged to be culprit) were diagnosed as IAD but not visible in DSA and 15 were Type I lesion. hrCMR is helpful in visualizing and characterizing IAD. It provides a significant complementary value over DSA for the diagnosis of IAD.

中文翻译：

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使用高分辨率心血管磁共振识别颅内动脉夹层的高危临床和影像特征

颅内动脉夹层（IAD）常引起头痛和脑血管缺血事件。IAD 的影像学特征尚不清楚。本研究旨在使用高分辨率心血管磁共振成像 (hrCMR) 来表征罪犯和非罪犯 IAD 的出现，并量化 hrCMR 在识别高风险病变方面的增量价值。收集在神经系统症状出现后 30 天内使用数字减影血管造影 (DSA) 和 hrCMR 使用 3 T CMR 系统进行干预检查或治疗的患者的影像数据。CMR 协议包括弥散加权成像 (DWI)、黑血 T1、T2 和对比增强 T1 加权序列。根据影像学发现和患者临床表现将病变分为罪犯和非罪犯。进行单变量和多变量分析以评估罪犯和非罪犯病变之间的差异以及 hrCMR 在识别高风险病变方面的互补价值。本研究共纳入 75 名患者。根据形态学，病变可分为五种类型：I型，经典夹层（n = 50）；II 型，梭形动脉瘤（n = 1）；III 型，长夹层动脉瘤（n = 3）；IV 型，长长的解剖动脉瘤（n = 9）和 V 型，囊状动脉瘤（n = 12）。回归分析显示年龄和高血压都与罪犯病变相关（年龄：OR，0.83；95% CI 0.75–0.92；p < 0.001，高血压：OR，66.62；95% CI 5.91–751.11；p = 0.001）。hrCMR 确定的血肿与罪犯病变显着相关（OR，16.80；95% CI 1.01–280.81；p = 0.037）。而且，17例（16个病变被判定为罪魁祸首）被诊断为IAD但在DSA中不可见，15例为I型病变。hrCMR 有助于可视化和表征 IAD。它为 IAD 的诊断提供了优于 DSA 的重要补充价值。