Imaging in the diagnosis and follow-up evaluation of vertebral artery dissection.

Abstract

The purpose of this report is to discuss the value of ultrasonographic examination in the diagnosis and follow-up evaluation of vertebral artery dissection. We collected data on 8 patients with 11 pathologic vessels: 9 were affected intracranially and 6 were affected extracranially. Four vessels were affected in both intracranial and extracranial segments. Extracranial color-flow duplex sonography could detect abnormalities in every extracranial vertebral artery dissection. Most abnormal findings were non-specific, including severely reduced flow, absence of flow, and absence of diastolic flow. A specific finding (intramural hematoma) was noted in one artery. Abnormal transcranial color-coded sonographic findings included absence of flow, reduced velocity and reversed flow direction. Three intracranial dissecting arteries showed normal findings on transcranial color-coded sonography. Ultrasonographic follow-up study revealed evidence of improvement; this was noted almost exclusively in the extracranial segments of the vertebral artery but infrequently in the intracranial segment. Extracranial color-flow duplex sonography is sensitive in the detection of extracranial vertebral artery dissection, both in initial diagnosis and in follow-up evaluation.

Ultrasound Diagnosis of Cervical Artery Dissection

“…4), a dissecting membrane, a true and false lumen, a pseudoaneurysm, and a tapering stenosis with distal occlusion [27,29]. Touboul et al [32] described the combination of local increase in vessel diameter with hemodynamic signs of stenosis or occlusion at the same level and decreased pulsatility and presence of intravascular echoes in the enlarged vessel as typical findings.…”

“…Conversely, most left V0 and V1 segments, the V4 segment, and the BA are insonated with sector (or Doppler) probes. Spontaneous dissection of the vertebral artery (sVAD) can affect all segments of the VA [27][28][29][30][31][32]. Thus, B-mode and color Doppler imaging will detect wall abnormalities, mainly in the right V0 and V1, both V2, and eventually both V3 segments.…”

Imaging the vertebral artery

“…more than 90% of cases, but specific signs like segmental dilatations with eccentric lumen are only seen in fewer than 20% of cases. Further confirmation using angiography or MRI/MRA is usually required [44,67]. The accuracy of ultrasound for dissection may be improved by the use of newer techniques such as B-Flow, which allows direct visualisation of blood reflectors.…”

Prognosis of spontaneous cervical artery dissection and transcranial Doppler findings associated with clinical outcomes

“…While the majority of sCAD cases show spontaneous resolution [4][5][6] and favourable long term outcomes [1][2][3][7][8][9], there is considerable variability in their clinical outcomes [1,3,10,11]. In this context, numerous studies investigated factors associated with unfavourable outcomes in order to detect high-risk patients and apply individualized treatment strategies.…”