doi: 10.3174/ajnr.A1189
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American Journal of Neuroradiology 29:1753-1760, October 2008
© 2008 American Society of Neuroradiology
HEAD & NECK
Comparison of Multidetector CT Angiography and MR Imaging of Cervical Artery Dissection
a Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
b Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, Calif
c Department of Radiology, Stanford University, Stanford, Calif
Please address correspondence to Greg Zaharchuk, PhD, MD, 1201 Welch Rd, PS-04, Stanford University Medical Center, Mailcode 5488, Stanford, CA 94305-5488; email: gregz{at}stanford.edu
BACKGROUND AND PURPOSE: Conventional angiography has been historically considered the gold standard for the diagnosis of cervical artery dissection, but MR imaging/MR angiography (MRA) and CT/CT angiography (CTA) are commonly used noninvasive alternatives. The goal of this study was to compare the ability of multidetector CT/CTA and MR imaging/MRA to detect common imaging findings of dissection.
MATERIALS AND METHODS: Patients in the data base of our Stroke Center between 2003 and 2007 with dissections who had CT/CTA and MR imaging/MRA on initial work-up were reviewed retrospectively. Two neuroradiologists evaluated the images for associated findings of dissection, including acute ischemic stroke, luminal narrowing, vessel irregularity, wall thickening/hematoma, pseudoaneurysm, and intimal flap. The readers also subjectively rated each vessel on the basis of whether the imaging findings were more clearly displayed with CT/CTA or MR imaging/MRA or were equally apparent.
RESULTS: Eighteen patients with 25 dissected vessels (15 internal carotid arteries [ICA] and 10 vertebral arteries [VA]) met the inclusion criteria. CT/CTA identified more intimal flaps, pseudoaneurysms, and high-grade stenoses than MR imaging/MRA. CT/CTA was preferred for diagnosis in 13 vessels (5 ICA, 8 VA), whereas MR imaging/MRA was preferred in 1 vessel (ICA). The 2 techniques were deemed equal in the remaining 11 vessels (9 ICA, 2 VA). A significant preference for CT/CTA was noted for VA dissections (P < .05), but not for ICA dissections.
CONCLUSION: Multidetector CT/CTA visualized more features of cervical artery dissection than MR imaging/MRA. CT/CTA was subjectively favored for vertebral dissection, whereas there was no technique preference for ICA dissection. In many cases, MR imaging/MRA provided complementary or confirmatory information, particularly given its better depiction of ischemic complications.