Evaluation of luminal and vessel wall abnormalities in subacute and other stages of intracranial vertebrobasilar artery dissections using the volume isotropic turbo-spin-echo acquisition (VISTA) sequence: a preliminary study

J Neuroradiol. 2013 Mar;40(1):19-28. doi: 10.1016/j.neurad.2012.02.005. Epub 2012 May 25.

Abstract

Objective: To evaluate the utility of 3D variable refocusing flip-angle volume isotropic turbo-spin-echo acquisition (VISTA) imaging, using a 1.5-T MRI unit, which can minimize flow artifacts, due to its sequence-endogenous flow-void capability, in the diagnosis of intracranial vertebrobasilar artery dissection (VAD).

Material and methods: The presence of intimal flaps, intramural hematomas, vessel dilatations and abnormal vessel enhancements were evaluated on T1-weighted VISTA images from 18 VAD patients with 20 dissected arteries (15 subacute and five at other stages). Additional gadolinium-enhanced T1VISTA images were available for 13 patients. The frequency of flow artifacts on T1VISTA imaging in 70 non-dissected arteries in VAD patients and 12 control subjects was also evaluated. Furthermore, in 13 and eight patients, contrast-enhanced three-dimensional (CE3D) imaging with spoiled gradient-recalled (SPGR) acquisition in steady state and electrocardiographically gated black-blood (BB) T1-weighted imaging (T1WI) were evaluated to compare visualization of false lumens.

Results: Intimal flaps, intramural hematomas and dilatations were identified on T1VISTA images in 65% (13/20), 55% (11/20) and 90% (18/20) of VADs, respectively. Abnormal vessel enhancement was recognized in 100% (15/15) of VADs on contrast-enhanced T1VISTA images. Only four normal arteries showed small, thin, linear artifacts. Compared with CE3D-SPGR imaging, T1VISTA imaging depicted false lumens more conspicuously in seven VADs (P=0.02). T1VISTA also revealed intimal flaps and hematomas as did BB T1WI.

Conclusion: T1VISTA imaging may be useful for diagnosing VAD at subacute stages, as it can reveal vessel wall and lumen abnormalities with a minimum of flow artifacts.

MeSH terms

  • Adult
  • Aged
  • Algorithms*
  • Aneurysm, Dissecting / pathology*
  • Anisotropy
  • Basilar Artery / pathology
  • Female
  • Humans
  • Image Enhancement / methods
  • Image Interpretation, Computer-Assisted / methods*
  • Imaging, Three-Dimensional / methods*
  • Intracranial Aneurysm / pathology*
  • Magnetic Resonance Angiography / methods*
  • Male
  • Middle Aged
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Spin Labels
  • Vertebral Artery / pathology

Substances

  • Spin Labels