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Compared with two-dimensional technique, three-dimensional HRMR VWI can provide isotropic spatial resolution images with higher spatial resolution in slice-selected direction, allowing visualization of the lesion in arbitrary orientations,[sup][29] which is helpful to detect small hematoma.[sup][66] VWI with three-dimensional black blood technique is regarded as optimum imaging tool for detecting intramural hematoma.[sup][81] In addition, intimal flap could be identified in more than 90.0% of IADs on T2-weighted images or postcontrast T1-weighted images.[sup][64],[65]{Figure 3}
In the first large cohort study by Ryoo et al .[sup][71] for comparing MMD (32 patients) with ICAD (16 patients) using HRMR VWI, MMD patients showed concentric enhancement on distal internal carotid arteries and MCAs regardless of symptoms or stages, whereas ICAD patients showed focal eccentric enhancement on the symptomatic segment.
Using HRMR VWI, culprit lesions could be detected, and mechanism of stroke could be better established.