Key result
Black-blood vessel wall imaging identifies delayed intracranial dissection, enabling successful antiplatelet management through 1 year.
Why the study?
Initial CT angiography and standard MRI/angiography did not adequately characterise the vessel wall pathology in a patient presenting with crescendo transient ischaemic attacks and a right M1 abnormality.
Case Report (n=1)
Post-contrast T1-weighted black-blood vessel wall imaging can help differentiate focal intracranial arterial dissection from atherosclerotic or inflammatory vasculopathy when standard angiography is inconclusive, and radiological progression to occlusion does not necessarily correspond to clinical deterioration.
Answers are grounded in this paper and cite their sources.
May aid differentiation of intracranial dissection when angiography is inconclusive; hypothesis-generating and requires prospective validation before practice change.
This report describes focal middle cerebral artery dissection presenting with crescendo transient ischaemic attacks. Initial CT angiography and standard MRI/angiography demonstrated right M1 abnormality and a small right basal ganglia infarct but did not adequately characterise the vessel wall pathology. Post-contrast T1-weighted black-blood vessel wall imaging performed 21 days after presentation demonstrated eccentric mural thickening and enhancement of the right M1 segment, with no discernible lipid core and no concentric mural thickening, supporting focal intracranial arterial dissection and making atherosclerotic and inflammatory vasculopathy less likely. Antiplatelet therapy was favoured over anticoagulation because of the intracranial location and potential haemorrhagic risk. Follow-up imaging showed progression to right M1 occlusion without clinical deterioration and the patient remained asymptomatic at 1 year, highlighting the need to integrate radiological evolution with clinical trajectory.
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Hissan et al. (2026) conducted a case report in Focal middle cerebral artery (right M1) dissection presenting with crescendo transient ischaemic attacks (n=1). Post-contrast T1-weighted black-blood vessel wall imaging and antiplatelet therapy was evaluated on Clinical status and radiological evolution at 1 year. Post-contrast T1-weighted black-blood vessel wall imaging at 21 days diagnosed focal right M1 dissection, and with antiplatelet therapy the patient remained asymptomatic at 1 year.
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