J Korean Soc Radiol.  2015 Nov;73(5):292-299. 10.3348/jksr.2015.73.5.292.

Symptomatic Isolated Middle Cerebral Artery Dissection: High Resolution MR Findings

• Byon JH
• Kwak HS
• Chung GH
• Hwang S

• KMID: 2079563
• DOI: http://doi.org/10.3348/jksr.2015.73.5.292

Abstract

PURPOSE
To perform high-resolution magnetic resonance imaging (HRMRI) and determine clinical features of patients with acute symptomatic middle cerebral artery (MCA) dissection.
MATERIALS AND METHODS
Thirteen patients with acute symptomatic MCA dissection underwent HRMRI within 3 days after initial clinical onset. They also underwent routine brain MR imaging. HRMRI examinations included time-of-flight MR angiography (MRA), T2-weighted, T1-weighted, proton-density-weighted, and three-dimensional magnetization-prepared rapid acquisition gradient-echo (MPRAGE) sequences. Conventional angiography and MRA were used as reference standard to establish the diagnosis of MCA dissection. The angiographic findings and HRMRI findings such as intimal flap, double lumen, and intramural hematoma were analyzed in this study.
RESULTS
All patients presented cerebral ischemia (median National Institutes of Health Stroke Scale score = 4, range = 0-18). String sign was seen on MRA in seven patients. However, double lumen was seen in all patients on HRMRI by intimal flap. High signal lesion on MPRAGE sequences around the dissection lumen due to intramural hematoma was seen in three patients.
CONCLUSION
HRMRI can be used to easily detect the wall structure of MCA such as the intimal flap and double lumen in patients with acute symptomatic MCA dissection. MPRAGE can detect hemorrhage in false lumen of MCA dissection.

MeSH Terms

Angiography
Brain
Brain Ischemia
Diagnosis
Hematoma
Hemorrhage
Humans
Magnetic Resonance Imaging
Middle Cerebral Artery*
National Institutes of Health (U.S.)
Stroke

Figure

• 

  Fig. 1 A 60-year-old woman with left MCA dissection and acute infarction of the basal ganglia (case 8). A. Diffusion weighted imaging showing diffusion restriction of the basal ganglia and multifocal focal infarction in the MCA territory. B. MRA showing severe stenosis of the left MCA (arrow). C. Cerebral angiography showing eccentric focal stenosis on the MCA (arrow). D. Proton density-weighted HRMRI showing intimal flap in the left MCA (arrow). HRMRI = high-resolution magnetic resonance imaging, MCA = middle cerebral artery

• 

  Fig. 2 A 46-year-old man with right MCA dissection and acute massive infarction of the MCA territory (case 2). A. Diffusion weighted imaging showing diffusion restriction of the right MCA territory. B. Volume rendering imaging of MRA showing complete occlusion of the right MCA (arrow). C, D. T1-weighted imaging (C) and MPRAGE imaging (D) showing high signal intensity (arrow) in the false lumen of the MCA dissection. MCA = middle cerebral artery, MPRAGE = magnetization-prepared rapid acquisition gradient-echo, MRA = MR angiography

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