Carotid and Vertebral Dissection Imaging

Abstract

Carotid or vertebral artery dissection is the result of a tear in the vessel lining wherein the intima separates the media. This creates a false or pseudo lumen, often accompanied by hemorrhage into the arterial wall. Dissection of these craniocervical vessels often manifests with pain alone but, if untreated, may result in severe neurologic compromise. The causes of dissection are multifactorial, including spontaneous, iatrogenic, and traumatic insults. Regardless of etiology, treatment consists primarily of anticoagulation, whereas endovascular therapy is reserved for cases with persistent thrombus or flow limitation. Given the high risk of neurological compromise or death and the propensity of these injuries to occur in younger individuals, early diagnosis of carotid and vertebral artery dissections is critical. Although angiography remains the criterion standard for diagnosis, advances in noninvasive imaging have placed magnetic resonance and computed tomography at the forefront of diagnosis. This article examines the current imaging modalities used to diagnose this under-recognized entity.

Postpartum Reversible Cerebral Vasoconstriction with Cortical Subarachnoid Hemorrhage and Posterior Reversible Encephalopathy Syndrome Concomitant with Vertebral Artery Dissection Diagnosed by MRI MSDE Method; A Case Report and Review of Literature.

“…18 IMH, which can be identi ed on MSDE, characteristically has a crescentic shape adjacent to the vessel lumen and often spirals along the length of the artery. 18,19,20 Previous reports suggested that the MSDE-3D-TSE sequence was useful for assessing vessel walls in the dissection and aneurysms. [21][22][23] MSDE causes phase dispersion of blood spin using a magnetic eld to suppress blood ow signal, producing 3D T1-weighted images.…”

Postpartum reversible cerebral vasoconstriction with cortical subarachnoid hemorrhage and posterior reversible encephalopathy syndrome concomitant with vertebral artery dissection diagnosed by MRI MSDE method; a case report and review of literature.

“…The presence of intramural hematoma (IMH) is the basis of the diagnosis of CAD [18]. IMH, which can be identified on MSDE, characteristically has a crescentic shape adjacent to the vessel lumen and often spirals along the length of the artery [18,19,20]. Previous reports suggested that the MSDE-3D-TSE sequence was useful for assessing vessel walls in the dissection and aneurysms [21][22][23].…”

Extracranial vertebral artery dissection

“…DSA is gradually being replaced by noninvasive imaging methods. [ 10 ] Concerning intramural hematoma, cross-sectional images of MRI have shown an advantage. Cristina et al [ 11 ] believe that MRI is the only reliable method for exploring the arterial wall.…”