Added value of high-resolution MR imaging in the diagnosis of vertebral artery dissection

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BACKGROUND AND PURPOSE: The optimal imaging method for the diagnosis of VAD remains undefined. Our aim was to evaluate the added value of HR-MR imaging for the diagnosis of VAD.<br /><br />MATERIALS AND METHODS: We retrospectively extracted 35 consecutive patients suspected of having acute VAD who had the following: 1) a focal lumen abnormality of the VA on CE-MRA, 2) HR-MR imaging during the initial hospital stay, and 3) clinical and imaging follow-up within 6 months. Two neurologists classified patients as either VAD (group A) or non-VAD (group B) by reviewing all the available data at hospital discharge, except HR-MR imaging data. On HR-MR imaging, 2 radiologists searched for signs of acute VAD. The 2 classifications were compared. In case of discordance, CE-MRA follow-up and axial fat-suppressed T1WI, used to obtain supportive evidence for or against VAD, were considered as the standard of reference.<br /><br />RESULTS: In 4/18 patients in group A, HR-MR imaging did not demonstrate any signs of acute VAD and perivertebral signal-intensity changes were attributed to venous plexus, with an unchanged lumen on follow-up. In 4/17 patients in group B, HR-MRI demonstrated a mural hematoma, with lumen normalization on follow-up CE-MRA.<br /><br />CONCLUSIONS: Our results encourage the use of HR-MR imaging as a second-line diagnostic tool in the event of suspicion of acute VAD and doubtful findings on standard imaging.




Naggara, O., Louillet, F., Touzé, E., Roy, D., Leclerc, X., Mas, J. L., … Oppenheim, C. (2010). Added value of high-resolution MR imaging in the diagnosis of vertebral artery dissection. American Journal of Neuroradiology, 31(9), 1707–1712.

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