Comparative analysis of imaging features and stroke-related factors between posterior circulation atherosclerosis and intramural hematoma-type dissection

• Published in: Clinical radiology Vol. 79; no. 11; pp. e1347 - e1355
• Main Authors: Ouyang, F., Wu, Q., Liu, J., Xu, Z., Lv, L., Pan, L., Wang, B., Zeng, X.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.11.2024
• ISSN: 0009-9260; 1365-229X; 1365-229X
• DOI: 10.1016/j.crad.2024.08.004

To compare the features detected by high resolution magnetic resonance vessel wall imaging (HR-VWI) between posterior circulation atherosclerosis and intramural hematoma (IMH)-type dissection, and to identify indicators related to cerebral ischemic events. Clinical and HR-VWI data of 55 patients with posterior circulation IMH-type dissection and 132 patients with posterior circulation atherosclerosis collected between October 2017 and October 2023 were analyzed retrospectively. Two radiologists independently extracted the imaging features. Multivariable logistic regression was used to identify factors independently associated with stroke. Compared with patients with atherosclerosis, those with IMH-type dissection were younger, with a lower prevalence of diabetes and hypertriglyceridemia, lower hypertension grade, enhanced grade, remodeling index (RI), vertebrobasilar artery/brainstem ratio, and prevalence of nonsmooth surface, and higher prevalence of intraluminal thrombus (ILT), lumen (LA), wall area (WA), and total vessel area (TVA). In patients with stroke, those with IMH-type dissection were younger, with a lower prevalence of diabetes, and degree of hypertension, and higher RI, WA, TVA, and the prevalence of ILT. Multivariable logistic regression showed that RI (odds ratio [OR], 0.37; 95% CI, 0.17–0.77) and normalized wall index (NWI) (OR, 39.02; 95% CI, 2.19–695.35) were risk factors for stroke in patients with dissection, and LA (OR, 1.52; 95% CI, 1.12–2.06) and NWI (OR, 60.84; 95% CI 3.70–998.06) were risk factors for atherosclerotic stroke. Patients with posterior circulation IMH-type dissection had greater potential for positive remodeling than those with atherosclerosis. The arterial remodeling capacity was closely related to stroke risk. •Remodeling capacity is related to stroke in atherosclerosis and IMH type dissection.•The remodeling capacity of IMH-type dissection is greater than atherosclerosis.•HR-VWI has a good ability to identify atherosclerotic lesions and IMH type dissection.