MRI and MR angiography of vertebral artery dissection |
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Authors: | M Mascalchi M C Bianchi S Mangiafico G Ferrito M Puglioli E Marin S Mugnai R Canapicchi N Quilici D Inzitari |
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Institution: | (1) Ph. D. Cattedra di Radiologia, Università di Pisa, Via Roma 67, I-56126 Pisa, Italy, IT;(2) Servizio di Neuroradiologia, Ospedale S. Chiara, Pisa,;(3) Servizio di Neuroradiologia, Ospedale di Careggi, Firenze,;(4) Servizio di Neuroradiologia, Ospedali Riuniti, Livorno,;(5) Servizio di Radiologia, Ospedale S. M. Nuova, Firenze,;(6) Clinica Neurologica, Università di Firenze, |
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Abstract: | A review of 4,500 angiograms yielded 11 patients with dissection of the vertebral arteries who had MRI and (in 4 patients)
MR angiography (MRA) in the acute phase of stroke. One patient with incidental discovery at arteriography of asymptomatic
vertebral artery dissection and two patients with acute strokes with MRI and MRA findings consistent with vertebral artery
dissection were included. Dissection occurred after neck trauma or chiropractic manipulation in 4 patients and was spontaneous
in 10. Dissection involved the extracranial vertebral artery in 9 patients, the extra-intracranial junction in 1, and the
intracranial artery in 4. MRI demonstrated infarcts in the brain stem, cerebellum, thalamus or temporo-occipital regions in
7 patients with extra- or extra-intracranial dissections and a solitary lateral medullary infarct in 4 patients (3 with intracranial
and 1 with extra-intracranial dissection). In 2 patients no brain abnormality related to vertebral artery dissection was found
and in one MRI did not show subarachnoid haemorrhage revealed by CT. Intramural dissecting haematoma appeared as crescentic
or rounded high signal on T1-weighted images in 10 patients examined 3–20 days after the onset of symptoms. The abnormal vessel
stood out in the low signal cerebrospinal fluid in intracranial dissections, whereas it was more difficult to detect in extracranial
dissections because of the intermediate-to-high signal of the normal perivascular structures and slow flow proximal and distal
to the dissection. In two patients examined within 36 h of the onset, mural thickening was of intermediate signal intensity
on T1-weighted images and high signal on spin-density and T2-weighted images. MRA showed abrupt stenosis in 2 patients and
disappearance of flow signal at and distal to the dissection in 5. Follow-up arteriography, MRI or MRA showed findings consistent
with occlusion of the dissected vessel in 6 of 8 patients.
Received: 27 February 1996 Accepted: 4 June 1996 |
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Keywords: | Arteries vertebral Arteries dissection Magnetic resonance imaging Magnetic resonance angiography |
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