• Masahiro Uemura, Kenshi Terajima, Yuji Suzuki, Masaki Watanabe, Yasuhisa Akaiwa, Shinichi Katada, Kouichirou Okamoto, Masatoyo Nishizawa, Hironaka Igarashi, and Tsutomu Nakada.
• Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan.
• J Neuroimaging. 2017 Jan 1; 27 (1): 293229-32.

Background And PurposePresence of an intimal flap is a critical imaging finding in diagnosing intracranial artery dissection (ICAD). Recent reports showed that high-resolution magnetic resonance imaging (MRI) was better at identifying intimal flaps as compared with routine MRI techniques used in clinical settings. However, no current standardized sequence for high-resolution MRI without gadolinium enhancement produces images of satisfactory quality with clinically tolerable scanning times. This study evaluated a nonenhanced high-resolution fast spin echo (HR-FSE) MRI sequence for visualizing intimal flaps in patients with ICAD.Subjects And MethodsThree patients with ICAD underwent plain MRI examination using a 2-dimensional T2-weighted FSE imaging sequence optimized for our 3T system (in-plane pixel size, .23 mm × .23 mm; slice thickness 3 mm with no interslice gap), as well as scanning with conventional modalities, including CT angiography, magnetic resonance angiography, and digital subtraction angiography. We assessed whether these imaging methods could visualize an intimal flap and/or double lumen sign in the participants and compared the results between HR-FSE and the other modalities.ResultsHR-FSE images clearly showed intimal flaps and double lumen signs in all 3 patients, whereas the conventional modalities identified a double lumen sign in only 2 of the 3 patients.ConclusionsThe present method of optimized HR-FSE imaging with a 3T system improved visualization of intimal flaps and should thus be considered for assessing patients with suspected ICAD that cannot be definitively diagnosed by conventional imaging modalities.Copyright © 2016 by the American Society of Neuroimaging.

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