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Imaging in the diagnosis and follow-up evaluation of vertebral artery dissection
1Department of Neurology, National Taiwan University Hospital, Taipei, Republic of China.
Insights
Ultrasonography effectively detects extracranial vertebral artery dissection, aiding diagnosis and follow-up. While it identifies abnormalities in most extracranial cases, intracranial segment improvement is less frequently observed.
Area of Science:
- Neurology
- Vascular Imaging
- Diagnostic Ultrasound
Background:
- Vertebral artery dissection (VAD) is a significant cause of stroke.
- Accurate diagnosis and monitoring are crucial for managing VAD.
- Ultrasonography offers a non-invasive approach to assess the vertebral arteries.
Observation:
- This study evaluated 8 patients with 11 affected vertebral arteries.
- Both extracranial and intracranial segments were assessed using color-flow duplex and transcranial color-coded sonography.
- Data focused on the diagnostic and follow-up capabilities of ultrasonography in VAD.
Findings:
- Extracranial color-flow duplex sonography detected abnormalities in all extracranial VAD cases.
- Common extracranial findings included reduced or absent flow and intramural hematoma.
- Transcranial sonography revealed absent flow, reduced velocity, or reversed flow in intracranial VAD, though three cases were normal.
- Ultrasonographic follow-up showed improvement primarily in extracranial segments.
Implications:
- Extracranial color-flow duplex sonography is a sensitive tool for diagnosing and monitoring extracranial VAD.
- Ultrasonography plays a valuable role in the comprehensive evaluation of vertebral artery dissection.
- Further research may explore optimizing transcranial sonography for intracranial VAD assessment.
Abstract:
The purpose of this report is to discuss the value of ultrasonographic examination in the diagnosis and follow-up evaluation of vertebral artery dissection. We collected data on 8 patients with 11 pathologic vessels: 9 were affected intracranially and 6 were affected extracranially. Four vessels were affected in both intracranial and extracranial segments. Extracranial color-flow duplex sonography could detect abnormalities in every extracranial vertebral artery dissection. Most abnormal findings were non-specific, including severely reduced flow, absence of flow, and absence of diastolic flow. A specific finding (intramural hematoma) was noted in one artery. Abnormal transcranial color-coded sonographic findings included absence of flow, reduced velocity and reversed flow direction. Three intracranial dissecting arteries showed normal findings on transcranial color-coded sonography. Ultrasonographic follow-up study revealed evidence of improvement; this was noted almost exclusively in the extracranial segments of the vertebral artery but infrequently in the intracranial segment. Extracranial color-flow duplex sonography is sensitive in the detection of extracranial vertebral artery dissection, both in initial diagnosis and in follow-up evaluation.