Which imaging studies are used in the diagnosis of vertebral artery dissection (VAD)?

Updated: Feb 21, 2019
  • Author: Eddy S Lang, MDCM, CCFP(EM), CSPQ; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Imaging studies in patients with suspected VAD may include the following:

  • Computed tomography (CT) scanning – Identifies subarachnoid hemorrhage [3] CT angiography (CTA), along with magnetic resonance angiography (MRA), are the imaging modalities of choice for vertebral artery dissections; however, CTA is less accurate in the presence of calcified arteries.

  • Magnetic resonance imaging [7, 8, 9, 10, 11] – Detects both the intramural thrombus and intimal flap that are characteristic of VAD [7] ; hyperintensity of the vessel wall seen on T1-weighted axial images is considered by some to be pathognomonic of VAD

  • MRA [8, 9, 10, 11, 12] – Can identify a pseudolumen and aneurysmal dilation of the artery [7]

  • Four-vessel cerebral angiography [7] – Once the criterion standard for diagnosis, now largely supplanted by noninvasive techniques

  • Vascular duplex scanning – Demonstrates abnormal flow in 95% of patients with VAD, [8] but shows signs specific to VAD (eg, segmental dilation of the vessel, eccentric channel) in only 20%

  • Transcranial Doppler ultrasonography – Approximately 75% sensitive to the flow abnormalities seen in VAD useful also in detecting high-intensity signals (HITS), which are characteristic of microemboli propagating distally as a result of the dissection; ultrasonography may have a role in the initial diagnosis of dissections if CT-A or MRA are unavailable.

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