After the tear, blood enters the arterial wall and forms a blood clot, thickening the artery wall and often impeding blood flow. Acr appropriateness criteria american college of radiology. One patient with incidental discovery at arteriography of asymptomatic vertebral artery dissection and two patients with acute strokes with mri and mra findings consistent with vertebral artery. Vertebral artery dissection vad is an increasingly recognized cause of stroke in patients younger than 45 years. Blood leaks through this tear and spreads between the layers of the wall. The entry and reentry sites can be clearly delineated arrows. This creates a false or pseudo lumen, often accompanied by hemorrhage into the arterial wall. Imaging characteristics of vertebral artery dissection.
Tissues with short t1 times like subcutaneous fat or fatty bone marrow appear bright tissues with long t1 times like fluid, cotical bone appear. Plan the sagittal pc 2d localiser on the coronal plane. We present a case of a 32 yearold righthand dominant woman who sustained a right brachial plexus injury, ipsilateral fractures of the cervical spine transverse processes, and vertebral artery dissection. Magnetic resonance imaging and vertebral artery dissection. Imaging series for dissections includes mr angiography mra coupled with mri of the head and neck. Although its pathophysiology and treatment closely resemble that of its sister condition, carotid artery dissection cad, the clinical presentation, etiology, and epidemiological profile of vads are unique.
Notice the normal flow void in the left vertebral artery. If the clot is large enough to completely block blood flow, this can result in a. Craniocervical artery dissection is a potentially disabling yet probably. Magnetic resonance imaging and clinical factors associated with.
Check the positioning block in the other two planes. Multisection ct angiography compared with catheter. Since the advent of advanced radiological modalities such as mri and magnetic resonance angiography mra, dissections of cervical arteries are increasingly recognised as a common cause of stroke in young adults. Conventional angiography might be avoided altogether in subjects with a suspicious. Spontaneous bilateral vertebral artery dissections.
High resolution mri sequences enable analysis of the arterial wall with. Recently, va dissection has become increasingly recognized as a source of stroke and subarachnoid hemorrhage sah. No acute intracranial hemorrhage or established acute cortical infarct. Mri basics quick hits t1 t1weighted images are generally considered to show the best anatomy although they are not that sensitive to pathology they have the best signaltonoise perunit time of scanning on t1weighted images. Detection of atherosclerosis using a novel positronsensitive probe. Vertebral artery dissection vad is a flaplike tear of the inner lining of the vertebral artery, which is located in the neck and supplies blood to the brain. This often causes an interruption of blood flow within the layers of the arterial wall, ultimately resulting in a blood clot in the artery. The findings through dissection and mri were consistent in regard to size of the vertebral veins and arteries. Vertebral artery dissections have an incidence of 15 per 100,000 10,11. A study was performed to evaluate the relationship between the imaging features and clinical presentation of vertebral artery va dissection. Craniocervical arterial dissection rsna publications online.
The imaging findings of acute vertebral artery dissection vad are well known. In vivo accuracy of multispectral magnetic resonance imaging for identifying lipidrich necrotic cores and intraplaque hemorrhage in advanced human carotid plaques. There is a dissection of the right vertebral artery from the v2 segment at the c23 level, extending into the v3 and v4 segments. As the blood collects in the area of the dissection, it forms a clot that limits blood flow through the artery. Twentytwo patients with 24 va dissections at angiography and clinical evaluation also underwent computed tomography and magnetic resonance imaging. In contrast, the right vertebral artery is poorly seen. Vertebral artery dissection is a potential cause of posterior circulation ischemia that requires highspatialresolution imaging for the definitive diagnosis. Spontaneous dissection of the vertebral artery svad is a potentially disabling and probably underdiagnosed cause of stroke mainly affecting young adults. Dissection involved the extracranial vertebral artery in 9 patients, the extraintracranial junction in 1, and the intracranial artery in 4.
Standard imaging protocols this document includes typical imaging protocols for diagnostic imaging. A three plane localiser must be taken in the beginning to localise and plan the sequences. Imaging of cervical artery dissection sciencedirect. She presented to us four days following the initiating accident. Vertebral artery dissection vad is an important cause of. Cervical artery dissection cad may affect the internal carotid andor the vertebral. Additionally, it does not require ionizing radiation or iodinated contrast. If the diagnosis of dissection is suspected, fatsuppression mri is the imaging study of choice.
Additional sequences in the imaging of vertebral artery dissection. However, risks associated with conventional angiography. Intracranial artery atherosclerosis, dissection, moyamoya disease. As shown in table 2, the mri findings as well as the dissection results revealed a plexus organization within the transverse canal 90%, with a predominant vein being involved in 75% of the cases. Oblique sagittal view, parallel slices, slice thickness 1. Mri 3d angiography in a patient with type b aortic dissection.
Conventional angiography has long been considered the gold standard for imaging of vertebral artery dissections. High resolution mri is therefore indicated in patients with suspected vertebral dissection and with a nonconclusive imaging profile, with a protocol oriented towards studying anomalies of the arterial wall detected on doppler ultrasound, t1 sequence with fat saturation, or mra of the supraaortic trunks. Vertebral artery dissection, like arterial dissection elsewhere, is a result of blood entering the media through a tear in the intima. The diagnosis of vertebral artery dissection is complicated by a lack of specific imaging requirements. Carotid or vertebral artery dissection is the result of a tear in the vessel lining wherein the intima separates the media. Chapter 7 clinical presentation of vertebral artery dissection dr james inklebarger vertebral artery dissection vad is a tear in the wall of the vertebral artery located in the neck. This creates a false or pseudo lumen, often accompanied by hemorrhage. Clinical presentation of vertebral artery dissection.
Mri is a highly accurate, noninvasive imaging modality, with a sensitivity of 95% to 98% and specificity of 94% to 98% for detecting aortic dissection. Mean age in vertebral artery dissection is 51 years and in carotid dissections. Employing these guidelines helps providers enhance quality of care and contribute to the most efficacious use of radiology. The area of bright signal represents blood inside the vessel wall from the dissection. Had lumbar puncture for rule out meningitis in the ed, negative. Traumatic vertebral artery dissection in an adult with. Digital subtraction angiography dsa remains the gold standard for assessment of the vertebrobasilar arteries, with excellent spatial and temporal resolution 2, 3.
Mri and mr angiography of vertebral artery dissection. Mri demonstrated infarcts in the brain stem, cerebellum, thalamus or temporooccipital regions in 7 patients with extra or extraintracranial dissections and a solitary lateral medullary infarct in 4. Vertebral artery dissection with a normalappearing lumen. Auer et al 1recently advocated mra as the initial diagnostic tool for vertebral artery dissection. Vertebral artery dissection which lead to cerebellar stroke. To prevent thromboembolic complications, anticoagulation with intravenous heparin followed by. The role of imaging in aortic dissection and related. Had a typical presentation in retrospect, neck pain, vertigo etc. Vertebral artery va dissection is an increasingly recognized cause of posteriorcirculation stroke in young and middleaged adults 1, 2. The mri mra dissection protocol for these patients included axial. Carotid plaque and iph were present if localized within 2 cm above or. Vertebral artery dissection vad is an important and underrecognized etiology of stroke in young patients. Tutorial on diagnosis of carotid and vertebral artery. The symptoms of vertebral artery dissection include head and neck pain and intermittent or permanent stroke.
Mri protocol aortic dissection rr school of nursing. This mri brain cross sectional anatomy tool is absolutely free to use. Vessel wall imaging of the intracranial and cervical carotid arteries. Spectrum of magnetic resonance imaging findings in vertebral. Carotid and vertebral dissection imaging request pdf. This study assessed the diagnostic value of various imaging findings in symptomatic vad. Use the mouse scroll wheel to move the images up and down alternatively use the tiny arrows on both side of the image to move the images. It is potentially lethal and can be difficult to diagnose clinically and radiologically. A guide for survivors and their loved ones dodds md, jodi a, anderson ms cccslp, amanda p on. No clinical symptoms or signs appear to be specific for vad.
Cervical artery dissection begins as a tear in one layer of the artery wall. Vertebral artery dissection is predominantly located in the pars. Diagnosis of vertebral artery dissection with basiparallel anatomical scanning magnetic resonance imaging december 2011 journal of nippon medical school 786. Surface reconstruction of a mri 3dangiography in a patient with type b aortic dissection. Single normal vertebral artery is sufficient to perfuse the basilar artery 2 embolic source. Magnetic resonance imaging showed normal brachial plexus along with vertebral artery. Vertebral artery dissection radiology reference article. Vertebral artery dissection an overview sciencedirect. To ensure that the radiologist protocols the correct study, if you want a dissection protocol mr, order. The article by naggara et al 1 on the added value of highresolution mr imaging in the diagnosis of vertebral artery dissection shows an interesting comparison between routine clinical mr imaging examinations as performed in their institution and highresolution imaging acquired with dedicated coils and different techniques. Fought through the symptoms for 34 days before presenting to the ed. Spontaneous vertebral artery dissection with thunderclap.
Anticoagulation is generally accepted as treatment, but evidence is not entirely clear. Spontaneous vertebral artery dissection with thunderclap headache. Fisp vessel size of vertebral artery dissection were significantly larger than those of the hypoplastic side of vertebral artery p dissection of the internal carotid artery or the vertebral artery va causes only 0. Tof mra mainly reflects the blood flow within the artery, representing the.