Outer lumen arterial imaging with CTA: A potential tool to diagnose vertebral artery dissection

Differentiating vertebral artery dissection (VAD) from vertebral artery hypoplasia (VAH) can be difficult with standard CT/CTA imaging. However, making this distinction is critical to providing appropriate patient management. In this brief report/technical note, we describe a new 3D CTA postprocessing technique to potentially distinguish VAD from VAH. We describe a case of right-sided VAD, where the initially rendered 3D images demonstrated a small inner lumen of the vertebral artery (VA). With this technique, VAD and VAH can potentially be conflated as the inner lumens in both conditions are narrow. A subsequent set of 3D images highlighted the outer lumen, which was relatively preserved - a finding in VAD but not VAH. With the proliferation of CTA imaging in the emergency setting, this 3D post processing technique can serve as an invaluable tool. Moreover, this technique offers the potential to be expanded and improved upon by utilizing deep learning (DL)-based segmentation.