What is the role of MRI 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...
  • Print
Answer

MRI 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. [7, 8, 9, 10, 11]

Park et al conducted a retrospective study of 41 vertebral arteries to evaluate radiologic findings according to the stages in spontaneous and unruptured, intracranial VAD (IVAD) on 3T high-resolution MRI (HR-MRI). [35] The 3T HR-MRI revealed the vessel wall characteristics as well as provided distinguishing findings between earlier stages and the chronic stage in spontaneous and unruptured IVAD. The investigators concluded that the characterization of these radiologic findings according to stages may help with the age estimation of the dissection. [35]

In a review of VAD cases registered between April 2008 and October 2014 that compared radiologic findings between patients with extracranial VAD (EVAD) and intracranial VAD (IVAD), Kobayashi et al found that intramural hematomas were more commonly revealed by MRI in patients with EVAD. [36] By contrast, in patients with IVAD, MRI and CT scanning more frequently revealed aneurysm formation.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!