What is the role of CT scanning in the workup 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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Answer

Data examining CTA versus magnetic resonance imaging-angiography (MRI-A)/MRA for VAD are limited, but there may be a slight preference for CTA for identifying VAD given the smaller arterial diameters compared to internal carotid dissections. [34] However, CTA is less accurate if heavy calcifications are present. CTA studies have a reported 90%-99% specificity and 40%-100% sensitivity for VAD.

CT scanning is useful in identifying patients with the complication of subarachnoid hemorrhage. [3]

Absence of hemorrhage, as demonstrated by CT scan, is a prerequisite for instituting anticoagulant therapy. Ease of access to CT scanners may provide the impetus for using CTA over MRA as the inital diagnostic study.


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