The essential role of multimodal magnetic resonance imaging in diagnosing vertebrobasilar artery dissection.

INTRODUCTION

Vertebrobasilar artery dissection (VBD) results from blood entering a tear in the intima of the vertebral artery (VA), basilar artery (BA), or their branches. T1-Sampling Perfection with Application-optimized Contrast using different flip angle Evolution (T1-SPACE) is a valuable tool for detecting intramural hematoma (IMH). Despite its potential, clinical adoption of susceptibility-weighted imaging (SWI) remains limited. This study aimed to clarify the usefulness of SWI and T1-SPACE for detecting IMH in VBD.

METHODS

Consecutive patients admitted with symptomatic VBD within 28 days of onset between November 2014 and September 2023 were retrospectively screened from the Jikei University School of Medicine Stroke Registry. Inclusion criteria were definitive VBD diagnosis based on Spontaneous Cervicocephalic Arterial Dissections Study criteria and simultaneous acquisition of SWI and T1-SPACE. IMH detectability was compared between the two sequences.

RESULTS

The study included 74 patients (52 males; median age, 45 years). IMH detection rates showed no significant difference between two sequences. The detection rate of IMH on SWI was relatively low in extracranial VA compared to intracranial VA or BA and PICA (3/8 vs. 62/66, p < 0.001), whereas on T1-SPACE, IMH was consistently detected in extracranial VA and intracranial VA or BA but was markedly lower in PICA (1/7 vs. 65/67, p < 0.001). Time from symptom onset to detection was similar across groups.

CONCLUSIONS

SWI demonstrated limited sensitivity for detecting IMH in extracranial VA, whereas T1-SPACE was less effective in PICA. Considering the site-specific differences in the culprit vessel, the combined use of both sequences may enhance diagnostic accuracy.