Abstract
Spontaneous vertebral artery dissection (VAD) is a rare but well-known cause of cerebrovascular disease and is often difficult to diagnose even using conventional arteriography. While noninvasive tests such as Doppler ultrasonography and magnetic resonance imaging (MRI) have failed to provide reliable criteria for the diagnosis of VAD, the diagnostic value of magnetic resonance angiography (MRA) has not yet been undetermined. To establish the reliability of a combined noninvasive approach, 11 patients were prospectively examined for VAD by means of colour-coded duplex studies, MRI and three-dimensional time-of-flight MRA prior to conventional angiography. Among 11 patients with VAD suspected clinically as well as on Doppler ultrasonography, angiography confirmed the diagnosis in seven patients but found a vertebral artery occlusion in three and a vertebral artery stenosis in one. The combination of MRI and MRA findings led to the correct diagnosis of dissection in three patients, of vertebral artery occlusion in three patients, and of vertebral artery stenosis in one. VAD was misinterpreted as vertebral artery occlusion in four patients. Doppler ultrasonography is a valuable screening method for the detection of vertebral artery pathologies. The diagnosis of VAD can only be established if a typical intramural vessel wall haematoma is seen on T1-weighted MRI in combination with MRA findings of irregular artery stenosis or occlusion.
Similar content being viewed by others
References
Biller J, Hintgen WL, Adams HP, Smoker WRK, Godersky JC, Toffol GJ (1986) Cervicocephalic arterial dissections: a ten year experience. Arch Neurol 43:1234–1238
Brugieres P, Castrec-Carpo A, Heran F (1989) Magnetic resonance imaging in the exploration of dissection of internal carotid artery. J Neuroradiol 16:1–10
Bui LN, Brant-Zawadzki M, Verghese P, GillanG (1993) Magnetic resonance angiography of cervicocranial dissection. Stroke 24:126–131
Chen J, Smith R, Keller A, Kucharczik W (1989) Spontaneous dissection of the vertebral artery: MR findings. J Comput Assist Tomogr 13:326–329
Chiras J, Marciano S, Vega Molina J, Touboul J, Poiries B, Bories J (1985) Spontaneous dissecting aneurysm of the extracranial vertebral artery (20 cases). Neuroradiology 27:327–333
Gelbert F, Assouline E, Hodes JE, Reizine D, Woimant F, George B, Hagueneau M, Merland JJ (1991) MRI in spontaneous dissection of vertebral and carotid arteries. 15 cases studied at 0.5 tesla. Neuroradiology 33:111–113
Goldberg H, Grossmen R, Gomori J, Ashbury A, Bilaniuk L, Zimmerman R (1986) Cervical internal carotid artery dissecting hemorrhage: diagnosis using MRI. Radiology 158:157–161
Hart RG (1988) Vertebral artery dissection. Neurology 38:987–989
Hennerici M, Steinke W, Rautenberg W (1989) High-resistance Doppler flow pattern in extracranial carotid dissection. Arch Neurol 46:670–676
Hennerici M, Mohr JP, Rautenberg W, Steinke W (1992) Ultrasound imaging and Doppler sonography in the diagnosis of cerebrovascular diseases. In: Barnett HJM, Mohr JP, Stein BM, Yatsu FM (eds) Stroke. Churchill Livingstone, Edinburgh, pp 241–268
Hoffmann M, Sacco RL, Chan S, Mohr JP (1993) Noninvasive detection of vertebral artery dissection. Stroke 24:815–819
Josien E (1992) Extracranial vertebral artery dissection: nine cases. J Neurol 239:327–330
Levy C, Laissy JP, Raveau V, Amarenco P, Servois V, Bousser MG, Tubiana JM (1994) Carotid and vertebral artery dissections: three-dimensional time-of-flight MR angiography and MR imaging versus conventional angiography. Radiology 190:97–103
Linden D, Steinke W, Schwartz A, Hennerici M (1992) Spontaneous vertebral artery dissection initially mimicking myocardial infarction. Stroke 23:1021–1023
Mas JL, Bousser MG, Hasboun D, Laplane D (1987) Extracranial vertebral artery dissections: a review of 13 cases. Stroke 18:1037–1047
Mas JL, Bousser MG, Touboul PJ (1992) Extracranial vertebral artery dissection. J Neurol Neurosurg Psychiatry 55:979–980
McCormick GF, Halbach VV (1993) Recurrent ischemic events in two patients with painless vertebral artery dissection. Stroke 24:598–602
Mokri B, Houser, DG, Sandok BA, Piepgras DG (1988) Spontaneous dissections of the vertebral arteries. Neurology 38:880–885
Quint DJ, Spickler EM (1990) Magnetic resonance demonstration of vertebral artery dissection. J Neurosurg 72:964–967
Ramenberg W, Schwartz A, Steinke W, Sliwka U, Hennerici M (1992) Doppler ultrasonography in vertebral artery dissection. Neurology 42:403
Rather J, Wentz KU, Rautenberg W, Schwartz A, Hennerici M (1993) MR-angiography in vertebrobasilar ischemia. Stroke 24:1310–1315
Rothrock JF, Lim V, Press G, Gosink B (1989) Serial magnetic resonance and carotid duplexexaminations in the management of carotid dissection. Neurology 39:686–692
Schwartz A, Mull M, Aulich A (1991) Vertebral artery dissection proved by follow-up. Neuroradiology 33:440–442
Steinke W, Rautenberg W, Schwartz A, Hennerici M (1994) Noninvasive monitoring of internal carotid artery dissection. Stroke 25:998–1055
Sturzenegger M, Mattle HP, Rivoir A, Rihs F, Schmid C (1993) Ultrasound findings in spontaneous extracranial vertebral artery dissection. Stroke 24:1910–1921
Sue DE, Brant-Zawadzki MN, Chance JTI (1992) Dissection of cranial arteries in the neck: correlation of MRI and arteriography. Neuroradiology 34:273–278
Touboul PJ, Mas JL, Bousser MG, Laplane D (1987) Duplex scanning in extracranial vertebral artery dissection. Stroke 18:116–121
Wentz KU, Rather J, Schwartz A, Mattle HP, Suchalla R, Edelman RR (1994) Intracranial vertebrobasilar system: MR angiography. Radiology 190:105–110
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Röther, J., Schwartz, A., Rautenberg, W. et al. Magnetic resonance angiography of spontaneous vertebral artery dissection suspected on Doppler ultrasonography. J Neurol 242, 430–436 (1995). https://doi.org/10.1007/BF00873545
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00873545