[논문]Diagnostic Usefulness of High Resolution Cross Sectional MRI in Symptomatic Middle Cerabral Arterial Dissection

Lee, Hai-Ong; Kwak, Hyo-Sung; Chung, Gyung-Ho; Hwang, Seung-Bae

doi:10.3340/jkns.2011.49.6.370

Diagnostic Usefulness of High Resolution Cross Sectional MRI in Symptomatic Middle Cerabral Arterial Dissection 원문보기

Journal of Korean Neurosurgical Society = 대한신경외과학회지, v.49 no.6, 2011년, pp.370 - 372

Lee, Hai-Ong (Department of Neurosurgery, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital) , Kwak, Hyo-Sung (Department of Radiology, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital) , Chung, Gyung-Ho (Department of Radiology, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital) , Hwang, Seung-Bae (Department of Radiology, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital)

Abstract ▼ AI-Helper

Dissection of the middle cerebral artery (MCA) is less frequent compared with dissection of the vertebrobasilar system or carotid artery. Recently, high-resolution cross sectional MR imaging (HRMRI) has emerged as a potential technique for atherosclerotic plaque imaging in MCA, We introduce the findings of HRMRI in a 56-year-old woman with traumatic MCA dissection, HRMRI showed an intimal flap and tapered pseudolumen with intra-luminal hemorrhage, We performed stent deployment about MCA dissection after failed medical treatment Three months later, there was no in-stent restenosis and no further neurological deficit were noted.

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가설 설정

2. A : Digit지 subtraction angiogram (DSA) after stent deployment shows complete recanalization of the right middle cerebral artery (MCA) and no visvaliz겨询i ofttie int而치 flap. B: Follow up DSA after 3 months, there is no in-stent restenosis.
A; Diffusion weighted MRI shows focal acute cerebral infarction of the right basal ganglia. B : Perfusion weighted MRI reveals severe perfusion decrease on ttie right middle ce-「曲间 artery (MCA) territory. C : HRMRI 이io临 a definite double lumen (arrow) with intramural hemorrhage.
A : Digit지 subtraction angiogram (DSA) after stent deployment shows complete recanalization of the right middle cerebral artery (MCA) and no visvaliz겨询i ofttie int而치 flap. B: Follow up DSA after 3 months, there is no in-stent restenosis.
B : Perfusion weighted MRI reveals severe perfusion decrease on ttie right middle ce-「曲间 artery (MCA) territory. C : HRMRI 이io临 a definite double lumen (arrow) with intramural hemorrhage. D : DSA presents MCA dissection due to h而ni기 flap.
C : HRMRI 이io临 a definite double lumen (arrow) with intramural hemorrhage. D : DSA presents MCA dissection due to h而ni기 flap.

대상 데이터

A 56-year-old woman was seen in the emergency department with left side weakness and dysarthria. She had ahistory of head trauma one-month prior by the traffic accident and did not show abnormal findings such as hemorrhage or inferction on brain computed tomography (CT) at that time.
For b엱th the PD-weighted and T2-weighted HR-MRI scans, the TSE sequence used a TR/TE=3000/80 ms for 17-weighted images and a TR/ TE=2500/30 for PD-weighted images. Both scans were run with FOV=120xl05 mm, matrix size=320x220, ETL-16, and NEX=4. The black blood technique with preregional saturation pulses of 80 mm thickness to saturate incoming arterial flow was 튾sed for all three scans.

이론/모형

Initial brain CT without c쟎utrast revealed no sign of hemorrhage. The patient visited to our institution within 2 hours of the onset of stroke symptoms and had serious neurologic symptoms as defined by a National Institutes of Health Stroke Scale score of 5. We started intravenous tissue-plasminogen activator.

성능/효과

We performed HRMRI for evaluation of MCA stenosis. The imaging parameters for the TOF-MRA scan were: repetition time (TR)/echo time (TE)=25/3.45 ms, flip angle= 2(T, h여d of view (FOV)=197x249 mm, matrix size=416x208, sensitivity encoding fector=2.5, slice thickness-0.60 mm, and number of averse (NEX)=1. The TOF-MRA scan time was 4 min.

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