Along with stenosis, intramural hematoma (IMH) detection significantly contributed to acute ischemic stroke pathogenesis in patients with suspected cervical artery dissection, a recent study found. In addition, IMH detection can be made more reliable with heavily T1-weighted sequences. Researchers conducted a retrospective study of 227 patients undergoing MRI/magnetic resonance angiography for suspected dissection. Imaging included standard turbo spin–echo (TSE) T1-fat saturation and heavily T1-weighted flow-suppressed magnetization-prepared rapid acquisition gradient–recalled echo sequences. Patients consisted of 41.9% men, mean age of 47.3±16.6 years, with 114 dissections and 107 strokes. They found:

• IMH interrater reliability was significantly higher for magnetization-prepared rapid acquisition gradient–recalled echo vs T1-fat saturation.
• The final acute stroke prediction model included magnetization-prepared rapid acquisition gradient–recalled echo-detected IMH, stenosis, pseudoaneurysm, male sex, current smoking, and nondissection stroke sources.
• The final model had high discrimination for acute stroke, compared with models without stenosis, and without stenosis and IMH.