Added Value of High-Resolution MR Imaging in the Diagnosis of Vertebral Artery Dissection

Naggara, Olivier; Louillet, F.; Touzé, Emmanuel; Roy, David P.; Leclerc, Xavier; Mas, Jean‐Louis; Pruvo, Jean‐Pierre; Méder, Jean-François; Oppenheim, Catherine

doi:10.3174/ajnr.a2165

Cited by 54 publications

(38 citation statements)

References 20 publications

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“…A reference standard, that is, neurological diagnosis of CD, may need to be considered in diagnostic research, 29 which is more in line with clinical practice.…”

Section: Strokementioning

confidence: 99%

“…Major and minor cervical trauma [13][14][15][16][17] Arterial hypertension [18][19][20] Young age 12 Current use of oral contraceptives 21 Migraine [22][23][24] Fibromuscular dysplasia 11,[25][26][27][28][29][30][31][32] Ultrastructural connective tissue abnormalities 33 Vascular subtype of Ehlers-Danlos syndrome 34 Marfan syndrome 18,35 Turner syndrome 19,36 Williams syndrome 37 Familial cases 18,38 Hereditary hemochromatosis 39 Osteogenesis imperfecta type I 40 α1-Antitrypsin deficiency 41,42 677T genotype MTHFR [43][44][45] Hyperhomocysteinemia 46 Cystic medial necrosis of intracranial vessels 47 Styloid process length 48 ICAM-1 E4690 K gene polymorphism 49 Autosomal-dominant polycystic kidney disease 50 Infections [51][52][53][54] Moyamoya disease …”

Section: Table 1 Factors Associated With CDmentioning

confidence: 99%

See 1 more Smart Citation

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Biller¹,

Sacco²,

Albuquerque³

et al. 2014

Stroke

179

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3155Purpose-Cervical artery dissections (CDs) are among the most common causes of stroke in young and middle-aged adults.The aim of this scientific statement is to review the current state of evidence on the diagnosis and management of CDs and their statistical association with cervical manipulative therapy (CMT). In some forms of CMT, a high or low amplitude thrust is applied to the cervical spine by a healthcare professional. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart Association's Manuscript Oversight Committee. Members were assigned topics relevant to their areas of expertise and reviewed appropriate literature, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. Results-Patients with CD may present with unilateral headaches, posterior cervical pain, or cerebral or retinal ischemia (transient ischemic or strokes) attributable mainly to artery-artery embolism, CD cranial nerve palsies, oculosympathetic palsy, or pulsatile tinnitus. Diagnosis of CD depends on a thorough history, physical examination, and targeted ancillary investigations. Although the role of trivial trauma is debatable, mechanical forces can lead to intimal injuries of the vertebral arteries and internal carotid arteries and result in CD. Disability levels vary among CD patients with many having good outcomes, but serious neurological sequelae can occur. No evidence-based guidelines are currently available to endorse best management strategies for CDs. Antiplatelet and anticoagulant treatments are both used for prevention of local thrombus and secondary embolism. Case-control and other articles have suggested an epidemiologic association between CD, particularly vertebral artery dissection, and CMT. It is unclear whether this is due to lack of recognition of preexisting CD in these patients or due to trauma caused by CMT. Ultrasonography, computed tomographic angiography, and magnetic resonance imaging with magnetic resonance angiography are useful in the diagnosis of CD. Follow-up neuroimaging is preferentially done with noninvasive modalities, but we suggest that no single test should be seen as the gold standard.

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“…A reference standard, that is, neurological diagnosis of CD, may need to be considered in diagnostic research, 29 which is more in line with clinical practice.…”

Section: Strokementioning

confidence: 99%

Section: Table 1 Factors Associated With CDmentioning

confidence: 99%

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Biller¹,

Sacco²,

Albuquerque³

et al. 2014

Stroke

179

View full text Add to dashboard Cite

show abstract

“…21,22 Briefly, the standardized stroke protocol included 6-mm-thick bicommissural axial fluid-attenuated inversion recovery (FLAIR), gradient recalled echo T2 or T2*, DWI using spin-echo echoplanar imaging, and noncontrast 3-dimensional time-of-flight MR angiography of the circle of Willis. The neck imaging protocol consisted of at least fast spin-echo T1-weighted fat-suppressed axial sequence followed by CE-MRA of brain-supplying arteries (intravenous meglumine gadoterate; Dotarem, Guerbet, France; 0.1 mmol/kg body weight) using an 8-channel phased-array coil for head and neck imaging.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Mechanism of Ischemic Infarct in Spontaneous Cervical Artery Dissection

Morel

Naggara

Touzé

et al. 2012

Stroke

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Background and Purpose-It is unclear whether strokes in patients with spontaneous cervical artery dissection (CAD) are due to secondary thromboembolism or to a reduction in cerebral blood flow from the primary cervical lesion. The aim of this study was to identify the most likely mechanism of stroke using cervical and cerebral imaging parameters in patients with CAD. Methods-The study was approved by the local Ethics Committee. Informed consent was waived. We retrospectively evaluated the cerebrovascular ultrasound, cervical MR angiography, and stroke brain MRI in consecutive patients with CAD. An embolic mechanism was considered in the case of direct visualization of an intracranial embolism as a susceptibility vessel sign on T2* or in the case of pial artery territory infarction on diffusion-weighted imaging. A hemodynamic mechanism was considered in the case of watershed infarction and in the case of an association of watershed infarction and pial artery territory infarction when Ն2 of the following were present: severe stenotic or occlusive CAD, reduced intracranial velocity on cerebrovascular ultrasound or signal on MR angiography, or hyperintense vessel sign on fluid-attenuated inversion recovery. The remaining patients were considered to have a mixed mechanism. Results-Of 172 consecutive patients with CAD, 100 (58%) had acute stroke on diffusion-weighted imaging. Stroke was attributed to a thromboembolic mechanism in 85 of 100 patients, a hemodynamic mechanism in 12 of 100 patients, and a mixed mechanism in 3 of 100 patients. Conclusions-Stroke in patients with CAD is most frequently associated with both direct and indirect signs of artery-to-artery embolization on imaging, a finding that should help design future therapeutic trials. (Stroke. 2012;43:1354-1361.)

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“…The vertebral arteries are prone to intracranial dissection, but their tortuous course, natural variation in caliber and small size make it difficult to reliably discern pathologic findings from normal variations or adjacent structures such as bone or venous plexuses [90]. Although studies have favorably compared IVWM of intracranial vertebral artery dissection to other sequences [9,91,92] such as TOF MRA and other 3D techniques that do not suppress blood signal like spoiled gradient-recalled (SPGR), only one study attempted to show statistical superiority for the IVWM sequences [8].…”

Section: Introductionmentioning

confidence: 99%

Intracranial vessel wall MRI: a review of current indications and future applications

et al. 2016

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Background: Intracranial vessel wall MRI (IVWM) is a new diagnostic imaging approach with the goal of evaluating intracranial vascular pathology by directly visualizing arterial vessel wall abnormalities with MR sequences, preferably at 3 Tesla field strength, that suppress blood and have excellent spatial resolution. Body: The differentiation of intracranial vascular pathology has historically relied on luminal imaging techniques that depict the alteration of flow created by atherosclerotic stenosis or vasospasm. With IVWM, it is possible to identify distinct radiologic findings of the pathology within the intracranial vessel wall itself, ranging from arterial dissection to vasculitis. Futhermore, IVWM imaging characteristics, such as post-contrast enhancement, can elucidate the temporal relationship between imaging findings and clinical pathology; and may predict future behavior of unruptured aneurysms or atherosclerotic plaques. Conclusion: We present a review of the basic IVWM imaging techniques and the relevant published literature on IVWM, with a focus on evidence-based diagnostic indications for IVWM and discussion of the strengths and weaknesses of each indication. Finally, we discuss how IVWM can be used to differentiate between intracranial pathology and future directions for IVWM research.

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Added Value of High-Resolution MR Imaging in the Diagnosis of Vertebral Artery Dissection

Cited by 54 publications

References 20 publications

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Mechanism of Ischemic Infarct in Spontaneous Cervical Artery Dissection

Intracranial vessel wall MRI: a review of current indications and future applications

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