Dissection of cervicocephalic arteries: early diagnosis and follow-up with magnetic resonance imaging

Abstract

Evaluate Magnetic Resonance (MR) and Magnetic Resonance Angiography (MRA) sensibility in the diagnosis and follow-up of dissection of Internal Carotid and Vertebral Artery (ICA/VA). We revalued MR examination of 36 patients, 24 men, 12 women, aged 18-69 years. All patients underwent brain TC and MR (GE 1 Tesla); in 16 subjects 3D Time-of-Flight (TOF-3D) MRA was performed and in 20 subjects a Contrast-Enhanced MRA (CEMRA) of neck and head arteries. Thirty-one patients underwent a MRA follow-up. Dissection involved ICA in 30 and VA in 8. MR showed ischemic signs in 25 cases, wall hematoma in 19, and was normal in 11. MRA showed 25 vessels stenosis, 12 occlusions, and 9 aneurysm. Follow-up MRA showed 6 cases of complete resolution of stenosis, 17 partial resolution, 2 aneurysmal dissecanting, 6 luminal alteration unchanged, 1 aneurysma enlarged. MRA represented a non-invasive technique as investigation in suspected cervicocephalic arteries dissection.

Craniocervical Arterial Dissection in Children: Diagnosis and Treatment

“…MRI/MRA had 50% to 100% sensitivity and 29% to 100% specificity [33,35–39]. In a more recent study of CCAD in adults, contrast-enhanced MRA was 89% sensitive for detection of CCAD, versus 50% for TOF MRA [40]. This finding mimics our clinical experience.…”

“…MRI/MRA can perform favorably compared with CA, and contrast-enhanced MRA is superior to TOF MRA. Compared with TOF MRA, contrast-enhanced MRA possesses several advantages in detecting arterial stenosis and dissection: imaging of the entire course of the cervical arteries in one acquisition [41], decreased overestimation of stenosis or occlusion due to slow flow [40], and fewer motion artifacts [42]. …”

Radiological imaging in acute ischaemic stroke

“…A fat suppressed T1‐weighted series is useful in identifying a hyperintense thrombus in the vessel wall in the case of acute dissection. However, this hyperintense signal usually develops within a few days owing to the transformation of haemoglobin to methaemoglobin and is therefore not always visible in the hyperacute phase .…”

Spontaneous carotid dissection with hypoglossal nerve palsy as residual deficit: the importance of magnetic resonance evaluation

“…This case highlights the importance of MRI with MR angiography as a diagnostic method. Its resolution approaches the conventional angiography and is able to show intramural hematoma, especially when fat suppression techniques are used 8 . The complementary exam also showed that the dissection extended to the petrous portion of the carotid artery, which is an uncommon event because usually the temporal bone represents a barrier to the pathologic process 1 .…”