Simultaneous non-contrast angiography and intraplaque haemorrhage (SNAP) imaging for cervical artery dissections

AIM: To evaluate the feasibility of high-resolution magnetic resonance imaging (MRI) with a simultaneous non-contrast angiography and intraplaque haemorrhage (SNAP) sequence in identifying cervical artery dissections (CeAD). MATERIALS AND METHODS: Fifty-three patients with suspected CeAD underwent the SNAP sequence (including non-contrast magnetic resonance angiography [MRA] and heavy T1-weighting vessel wall images simultaneously in a single scan) and conventional MRI sequences (including three-dimensional [3D] time-of-flight MRA and T1-weighted black-blood imaging [T1W BB]) and cervical vascular ultrasound (CVUS). In diagnosis of CeAD, the diagnostic sensitivity and specificity of SNAP, and the diagnostic coherence between SNAP and conventional sequences and between SNAP and CVUS was analysed. At follow-up, the absolute signal (AS) and signal index (SI) of the intramural haematoma (IMH) between vessel wall images on SNAP and T1W-BB images were compared. The image quality of SNAP was analysed by comparing the signal-to-noise ratio (SNR) between vessel wall images from the SNAP and T1W-BB sequences. RESULTS: The SNAP sequence was found to provide good performance in the diagnosis of CeAD (sensitivity 72.2%, specificity 98.2%); good agreement was found between SNAP and conventional sequences (Cohen's kappa=0.76, p<0.05); and excellent agreement was found between SNAP and CVUS (Cohen's kappa=0.83, p<0.05). There was no significant difference between AS or SI of the IMH of the vessel wall images within the SNAP and T1W-BB sequences during the review. The SNAP sequence had higher SNR of the IMH compared to T1W-BB, T2W-BB, proton-density-weighted volume isotropic turbo-spin-echo acquisition imaging (PD-VISTA) sequences (p<0.05). CONCLUSION: The SNAP sequence holds the potential to be preferred choice for screening of patients with a high suspicion of CeAD and for the follow-up of IMH after treatment. (C) 2019 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.