Magnetic resonance imaging study of intracranial vertebrobasilar artery dissections

The purpose of this study is to demonstrate the magnetic resonance features of intracranial vertebrobasilar artery dissections and to determine the potential and limitations of magnetic resonance imaging in their diagnosis.

We studied five consecutive patients with angiographically verified intracranial vertebrobasilar artery dissection with magnetic resonance imaging (0.5 T) in regard to the shapes of the intramural hematoma and the chronological change of its signal intensity. We also estimated the sensitivity of magnetic resonance imaging for diagnosing dissection.

We observed intramural hematoma in four patients on the first magnetic resonance scan and in all five patients during the course of the study. The shapes of the intramural hematomas were curvilinear, crescentic, "bamboo-cut," "band-like," and spotty. The intensity of the intramural hematoma varied according to its age. On the T1-weighted and the proton images, the intramural hematomas appeared isointense to slightly hyperintense in the first few days and became hyperintense thereafter. The intramural hematomas became isointense or unrecognizable 2 months after onset. The T1-weighted image and the proton images were superior to the T2-weighted image in demonstrating the intramural hematomas.

Magnetic resonance imaging is a sensitive tool for diagnosing intracranial vertebrobasilar artery dissection, particularly in the subacute to early chronic stage. Magnetic resonance imaging is complementary to angiography in that it can directly visualize intramural hematomas.