Jaewon Shin1, Jong-Won Chung1, Moo Seok Park1, Hanul Lee1, Jihoon Cha1, Woo-Keun Seo1, Gyeong-Moon Kim1, Oh Young Bang2. 1. From the Departments of Neurology (J.S., J.-W.C., M.S.P., H.L., W.-K.S., G.-M.K., O.Y.B.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; Departments of Radiology (J.C.), Severance Hospital, Yonsei University College of Medicine, Seoul; and Translational and Stem Cell Research Laboratory on Stroke (J.-W.C., O.Y.B.), Samsung Medical Center, Seoul, Republic of Korea. 2. From the Departments of Neurology (J.S., J.-W.C., M.S.P., H.L., W.-K.S., G.-M.K., O.Y.B.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; Departments of Radiology (J.C.), Severance Hospital, Yonsei University College of Medicine, Seoul; and Translational and Stem Cell Research Laboratory on Stroke (J.-W.C., O.Y.B.), Samsung Medical Center, Seoul, Republic of Korea. ohyoung.bang@samsung.com.
Abstract
OBJECTIVE: To compare the outcomes between patients with nontraumatic intracranial arterial dissection (ICAD) and intracranial atherosclerotic stenosis (ICAS) using high-resolution MRI (HR-MRI). METHODS: We conducted a prospective study using HR-MRI in patients with acute symptomatic cerebrovascular disease due to intracranial occlusive disease and no dissection on luminal images. Patients were followed-up for 27.9 ± 19.3 months. We compared the functional outcome, recurrence, and changes in vascular status between patients with ICAD (dissection and no plaque on HR-MRI) and ICAS (atherosclerosis plaque on HR-MRI). RESULTS: We included 312 patients (mean age, 59.0 ± 14.2 years; men, 58.3%), of whom 113 had ICAD and 199 had ICAS. The functional outcome (as measured by modified Rankin Scale score) on the 90th day after symptom onset was not different between the groups, after adjusted for other factors (p = 0.095). However, recurrent ischemic cerebrovascular disease on the relevant vascular territory was lower in the ICAD group (7 patients, 6.2%) than in the ICAS group (37 patients, 18.6%). ICAD was a significant independent determinant of disease recurrence (hazard ratio, 0.43; 95% confidence interval, 0.19-0.98). Improvement in vascular stenosis on follow-up vascular studies was more frequently observed in ICAD (50.7%) than in ICAS (11.6%). ICAD was an independent determinant of vascular improvement (odds ratio, 7.94; 95% confidence interval, 3.32-19.01). CONCLUSION: Considering the high prevalence of ICAD in the patients with presumed ICAS and the differential outcomes between ICAD and ICAS, HR-MRI may be a useful diagnostic tool in this population.
OBJECTIVE: To compare the outcomes between patients with nontraumatic intracranial arterial dissection (ICAD) and intracranial atherosclerotic stenosis (ICAS) using high-resolution MRI (HR-MRI). METHODS: We conducted a prospective study using HR-MRI in patients with acute symptomatic cerebrovascular disease due to intracranial occlusive disease and no dissection on luminal images. Patients were followed-up for 27.9 ± 19.3 months. We compared the functional outcome, recurrence, and changes in vascular status between patients with ICAD (dissection and no plaque on HR-MRI) and ICAS (atherosclerosis plaque on HR-MRI). RESULTS: We included 312 patients (mean age, 59.0 ± 14.2 years; men, 58.3%), of whom 113 had ICAD and 199 had ICAS. The functional outcome (as measured by modified Rankin Scale score) on the 90th day after symptom onset was not different between the groups, after adjusted for other factors (p = 0.095). However, recurrent ischemic cerebrovascular disease on the relevant vascular territory was lower in the ICAD group (7 patients, 6.2%) than in the ICAS group (37 patients, 18.6%). ICAD was a significant independent determinant of disease recurrence (hazard ratio, 0.43; 95% confidence interval, 0.19-0.98). Improvement in vascular stenosis on follow-up vascular studies was more frequently observed in ICAD (50.7%) than in ICAS (11.6%). ICAD was an independent determinant of vascular improvement (odds ratio, 7.94; 95% confidence interval, 3.32-19.01). CONCLUSION: Considering the high prevalence of ICAD in the patients with presumed ICAS and the differential outcomes between ICAD and ICAS, HR-MRI may be a useful diagnostic tool in this population.