Using the Region of Interest from Time-of-Flight Magnetic Resonance Angiography to Differentiate between Intracranial Arterial Dissection and True Atherosclerotic Stenosis

Jung Won Hwang, Jin-Man Jung, Jae Hyung Cha, Il Eok Jung, Moon Ho Park, Do-Young Kwon, Jiyeon Kim, Yool Hee Kim, Sang Hun Lee

Research output: Contribution to journalArticle

Abstract

Background: Noncontrast three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) is commonly used to examine intracranial arterial stenosis, although it can be difficult to identify the etiology of the stenosis. Our aim was to determine the effectiveness of 3D TOF MRA in differentiating an intracranial arterial dissection from atherosclerosis. Methods: During 2015-2017, 356 patients had confirmed intracranial arterial stenosis based on high resolution-magnetic resonance imaging. This study ultimately included 51 patients with severe focal stenosis that was caused by dissection and atherosclerosis. We compared the dissection group with the atherosclerotic narrowing group by measuring the region-of-interest (ROI) values 3 mm proximal and 3 mm distal from sites of severe focal stenosis. Results: A significant difference was observed between the median ROI difference values in the dissection group (n = 18) and the atherosclerosis group (n = 33; 35.6 [20.9-78.4] vs. 165.5 [99.8-328.5]; p < 0.001). A receiver operating characteristic curve was prepared to distinguish between dissection and atherosclerosis using the ROI difference values. The area under the curve was 0.919 (sensitivity 75.8%, specificity 94.4%). The optimal cutoff value for using ROI to distinguish between dissection and atherosclerosis was found to be 99.0 based on the Youden's index. Conclusion: The ROI difference value from 3D TOF MRA could help distinguish between dissection and atherosclerosis. If the ROI difference value from 3D TOF MRA is small (< 99.0), detailed testing should be performed to identify dissection.

Original languageEnglish
Pages (from-to)8-14
Number of pages7
JournalCerebrovascular Diseases
DOIs
Publication statusPublished - 2019 Jan 1

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Magnetic Resonance Angiography
Dissection
Pathologic Constriction
Atherosclerosis
ROC Curve
Area Under Curve
Magnetic Resonance Imaging
Sensitivity and Specificity

Keywords

  • Atherosclerosis
  • Dissection
  • Time-of-flight magnetic resonance angiography

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Using the Region of Interest from Time-of-Flight Magnetic Resonance Angiography to Differentiate between Intracranial Arterial Dissection and True Atherosclerotic Stenosis. / Hwang, Jung Won; Jung, Jin-Man; Cha, Jae Hyung; Jung, Il Eok; Park, Moon Ho; Kwon, Do-Young; Kim, Jiyeon; Kim, Yool Hee; Lee, Sang Hun.

In: Cerebrovascular Diseases, 01.01.2019, p. 8-14.

Research output: Contribution to journalArticle

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abstract = "Background: Noncontrast three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) is commonly used to examine intracranial arterial stenosis, although it can be difficult to identify the etiology of the stenosis. Our aim was to determine the effectiveness of 3D TOF MRA in differentiating an intracranial arterial dissection from atherosclerosis. Methods: During 2015-2017, 356 patients had confirmed intracranial arterial stenosis based on high resolution-magnetic resonance imaging. This study ultimately included 51 patients with severe focal stenosis that was caused by dissection and atherosclerosis. We compared the dissection group with the atherosclerotic narrowing group by measuring the region-of-interest (ROI) values 3 mm proximal and 3 mm distal from sites of severe focal stenosis. Results: A significant difference was observed between the median ROI difference values in the dissection group (n = 18) and the atherosclerosis group (n = 33; 35.6 [20.9-78.4] vs. 165.5 [99.8-328.5]; p < 0.001). A receiver operating characteristic curve was prepared to distinguish between dissection and atherosclerosis using the ROI difference values. The area under the curve was 0.919 (sensitivity 75.8{\%}, specificity 94.4{\%}). The optimal cutoff value for using ROI to distinguish between dissection and atherosclerosis was found to be 99.0 based on the Youden's index. Conclusion: The ROI difference value from 3D TOF MRA could help distinguish between dissection and atherosclerosis. If the ROI difference value from 3D TOF MRA is small (< 99.0), detailed testing should be performed to identify dissection.",
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AU - Cha, Jae Hyung

AU - Jung, Il Eok

AU - Park, Moon Ho

AU - Kwon, Do-Young

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AU - Kim, Yool Hee

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AB - Background: Noncontrast three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) is commonly used to examine intracranial arterial stenosis, although it can be difficult to identify the etiology of the stenosis. Our aim was to determine the effectiveness of 3D TOF MRA in differentiating an intracranial arterial dissection from atherosclerosis. Methods: During 2015-2017, 356 patients had confirmed intracranial arterial stenosis based on high resolution-magnetic resonance imaging. This study ultimately included 51 patients with severe focal stenosis that was caused by dissection and atherosclerosis. We compared the dissection group with the atherosclerotic narrowing group by measuring the region-of-interest (ROI) values 3 mm proximal and 3 mm distal from sites of severe focal stenosis. Results: A significant difference was observed between the median ROI difference values in the dissection group (n = 18) and the atherosclerosis group (n = 33; 35.6 [20.9-78.4] vs. 165.5 [99.8-328.5]; p < 0.001). A receiver operating characteristic curve was prepared to distinguish between dissection and atherosclerosis using the ROI difference values. The area under the curve was 0.919 (sensitivity 75.8%, specificity 94.4%). The optimal cutoff value for using ROI to distinguish between dissection and atherosclerosis was found to be 99.0 based on the Youden's index. Conclusion: The ROI difference value from 3D TOF MRA could help distinguish between dissection and atherosclerosis. If the ROI difference value from 3D TOF MRA is small (< 99.0), detailed testing should be performed to identify dissection.

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