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Imaging of Spontaneous and Traumatic Cervical Artery Dissection : Comparison of Typical CT Angiographic Features

Peter B Sporns1, Thomas Niederstadt2, Walter Heindel2

  • 1Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany. peter.sporns@ukmuenster.de.

Clinical Neuroradiology
|January 28, 2018
PubMed

Insights

Traumatic cervical artery dissection (CAD) often presents with intimal flaps and multivessel involvement, unlike spontaneous CAD. Computed tomography angiography (CTA) is crucial for diagnosing CAD in trauma patients, even without cervical spine fractures.

Area of Science:

  • Radiology
  • Neurology
  • Vascular Surgery

Background:

  • Cervical artery dissection (CAD) is a significant cause of ischemic stroke, necessitating prompt diagnosis to prevent cerebral embolization.
  • While catheter angiography is the traditional standard, computed tomography angiography (CTA) shows promise in detecting CAD.
  • Understanding the imaging characteristics of spontaneous versus traumatic CAD is crucial for accurate diagnosis and patient management.

Purpose of the Study:

  • To evaluate the frequency and variety of imaging signs associated with spontaneous and traumatic cervical artery dissection.
  • To compare the imaging features of traumatic CAD (tCAD) and spontaneous CAD (sCAD).
  • To provide guidance for neuroradiologists in differentiating CAD etiologies based on imaging findings.

Main Methods:

  • Retrospective review of trauma patients with tCAD and stroke patients with sCAD admitted to a level 1 trauma center and stroke database (2008-2015).
  • Analysis of CT/CTA scans performed during initial clinical work-up for all included patients.
  • Evaluation of specific and sensitive radiological features for dissection by two experienced neuroradiologists, with comparative analysis between etiologies.

Main Results:

  • The study included 145 patients (126 traumatic, 43 spontaneous CAD).
  • Intimal flaps were significantly more common in tCAD (58.1%) compared to sCAD (6.9%) (p < 0.001).
  • Multivessel dissections were more frequent in trauma patients (21 tCADs vs. 3 sCADs), and only 42% of traumatic cases had associated cervical spine fractures.

Conclusions:

  • Neuroradiologists should recognize that intimal flaps and multivessel dissections are more indicative of traumatic etiology.
  • CTA is recommended in trauma settings for CAD evaluation, irrespective of the presence of cervical spine fractures.
  • Differentiating between traumatic and spontaneous CAD based on imaging features aids in appropriate patient management and treatment.
Abstract

Keywords:
Internal carotid artery dissectionMultidetector computed tomographyNeuroimagingSpontaneous vertebral artery dissectionTraumatic vertebral artery dissection

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