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Between 2007 and 2010 more than 50 patients with spontaneous dissections of cervical arteries have been examined and scanned with a modified cervical MRI and fluorodeoxyglucose (18F) PET CT protocol at the Institute of Clinical Radiology, LMU Munich. Within this prospective, mono-centric study all imaging data was obtained by using a 3.0 tesla scanner (Magnetom Verio; Siemens Healthcare) and two PET CT scanners (Philips Gemini; Philips Healthcare and Siemens Biograph 64; Siemens Healthcare). This study was based on and conducted by a strong cooperation between the Department of Neurology and the Department of Nuclear Medicine. Detailed data sets regarding patient history and clinical parameters were recorded for every patient. The MRI protocol included a time-of-flight angiography, fat-saturated T1- and T2- weighted black-blood sequences before and after the administration of contrast medium (Gadovist®, Bayer-Schering). The scans covered the supra-aortic vessels from the aortic arch to the base of the skull with a best in plane resolution of 0.5 x 0.5 mm2. Every patient received an additional diffusion-weighted brain-MRI for evaluation of ischemia. The supra-aortic vessels of the same patients were also scanned by a low dose FDG/PET-CT. Measurements of standardized uptake values for every vessel segment were obtained after the administration of the tracer (activity: 5 MBq/kg bodyweight). The calculated effective dose was 8 mSv per patient. Along with quantitative PET-CT analysis, experienced radiologists performed qualitative evaluation of vessel wall inflammation for PET-CT and the MR images. Local inflammatory changes at the site of dissection were distinguished from generalized inflammation of the vascular system., For the study of Pfefferkorn et al (Stroke 2011) 37 patients with spontaneous cervical dissection matched the inclusion criteria. In 27 patients (83%) PET-CT showed significant perivascular FDG-uptake at the site of dissection. 8 Patients (24%) showed signs of generalized inflammation with increased FDG-uptake at additional vessel segments (e.g. aortic arch). We found a strong positive correlation between the presence of dissection and perivascular contrast enhancement (Pearson´s r=0.73; p, The study of Habs et al (JCMR 2011) investigated the age determination of vessel wall hematomas by MRI in 35 patients with spontaneous cervical artery dissection. The vessel wall hematomas were classified according to their relative signal intensities on T1- and T2-weighted images and were described as either acute, early subacute, late subacute or chronic. Only patients with a clear clinical onset of symptoms typical for cervical artery dissection (e.g. Horner's syndrome, TIA, stroke) were included in this study, so that the age of the dissection could be determined. Based on the MRI assessment of the vessel wall hematomas the mean age of the dissection for early subacute, late subacute and chronic appearance of the hematoma differed significantly from each other (5.8 vs. 15.7 vs. 58.7 days). There was a strong agreement between the MRI based classification and the age of the hematoma (Cohen´s kappa 0.74; p

Background Previously proposed classifications for carotid plaque and cerebral parenchymal hemorrhages are used to estimate the age of hematoma according to its signal intensities on T1w and T2w MR images. Using these classifications, we systematically investigated the value of cardiovascular magnetic resonance (CMR) in determining the age of vessel wall hematoma (VWH) in patients with spontaneous cervical artery dissection (sCAD). Methods 35 consecutive patients (mean age 43.6 ± 9.8 years) with sCAD received a cervical multi-sequence 3T CMR with fat-saturated black-blood T1w-, T2w- and TOF images. Age of sCAD was defined as time between onset of symptoms (stroke, TIA or Horner's syndrome) and the CMR scan. VWH were categorized into hyperacute, acute, early subacute, late subacute and chronic based on their signal intensities on T1w- and T2w images. Results The mean age of sCAD was 2.0, 5.8, 15.7 and 58.7 days in patients with acute, early subacute, late subacute and chronic VWH as classified by CMR (p < 0.001 for trend). Agreement was moderate between VWH types in our study and the previously proposed time scheme of signal evolution for cerebral hemorrhage, Cohen's kappa 0.43 (p < 0.001). There was a strong agreement of CMR VWH classification compared to the time scheme which was proposed for carotid intraplaque hematomas with Cohen's kappa of 0.74 (p < 0.001). Conclusions Signal intensities of VWH in sCAD vary over time and multi-sequence CMR can help to determine the age of an arterial dissection. Furthermore, findings of this study suggest that the time course of carotid hematomas differs from that of cerebral hematomas.