MRI of intracranial vertebral artery dissection: evaluation of intramural haematoma using a black blood, variable-flip-angle 3D turbo spin-echo sequence

Neuroradiology. 2013 Jul;55(7):845-51. doi: 10.1007/s00234-013-1183-4. Epub 2013 Apr 26.


Introduction: We investigated the efficacy of three-dimensional black blood T1-weighted imaging (3D-BB-T1WI) using a variable refocusing flip angle turbo spin-echo sequence in the diagnosis of intracranial vertebral artery dissection (VAD).

Methods: Sixteen consecutive patients diagnosed with intracranial VAD underwent magnetic resonance imaging that included 3D time-of-flight-MRA, axial spin-echo T1-weighted images (SE-T1WI) and oblique coronal 3D-BB-T1WI sequences. The visualization, morphology and extent of intramural haematomas were assessed and compared among the sequences. Results obtained by digital subtraction angiography (DSA), 3D-angiography and/or 3D-CT angiography (CTA) were used as standards of reference.

Results: 3D-BB-T1WI revealed intramural haematomas in all cases, whereas SE-T1WI and magnetic resonance angiography (MRA) failed to reveal a haematoma in one case and three cases, respectively. The mean visualization grading score for the intramural haematoma was the highest for 3D-BB-T1WI, and there was a statistically significant difference among the sequences (p < 0.001). At least a portion of the intramural haematoma was distinguishable from the lumen on 3D-BB-T1WI, whereas the haematomas were entirely indistinguishable from intraluminal signals on MRA in two cases (12.5%) and on SE-T1WI in one case (6.3%). 3D-BB-T1WI revealed the characteristic crescent shape of the intramural haematoma in 14 cases (87.5%), whereas SE-T1WI and MRA revealed a crescent shape in only 7 cases (43.8%) and 8 cases (50%), respectively. In a consensus reading, 3D-BB-T1WI was considered the most consistent sequence in representing the extent and morphology of the lesion in 14 cases (87.5%), compared to DSA and CTA.

Conclusion: 3D-BB-T1WI is a promising method to evaluate intramural haematoma in patients with suspected intracranial VAD.

MeSH terms

  • Adult
  • Algorithms
  • Cerebral Angiography / methods*
  • Female
  • Hematoma, Epidural, Cranial / etiology*
  • Hematoma, Epidural, Cranial / pathology*
  • Humans
  • Image Enhancement / methods
  • Image Interpretation, Computer-Assisted / methods
  • Imaging, Three-Dimensional / methods*
  • Magnetic Resonance Angiography / methods*
  • Male
  • Middle Aged
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Vertebral Artery Dissection / complications*
  • Vertebral Artery Dissection / pathology*