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Research ArticleBrain

Added Value of High-Resolution MR Imaging in the Diagnosis of Vertebral Artery Dissection

O. Naggara, F. Louillet, E. Touzé, D. Roy, X. Leclerc, J.-L. Mas, J.-P. Pruvo, J.-F. Meder and C. Oppenheim
American Journal of Neuroradiology October 2010, 31 (9) 1707-1712; DOI: https://doi.org/10.3174/ajnr.A2165
O. Naggara
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F. Louillet
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E. Touzé
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D. Roy
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X. Leclerc
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J.-L. Mas
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J.-P. Pruvo
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J.-F. Meder
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C. Oppenheim
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Abstract

BACKROUND AND PURPOSE: The optimal imaging method for the diagnosis of VAD remains undefined. Our aim was to evaluate the added value of HR-MR imaging for the diagnosis of VAD.

MATERIALS AND METHODS: We retrospectively extracted 35 consecutive patients suspected of having acute VAD who had the following: 1) a focal lumen abnormality of the VA on CE-MRA, 2) HR-MR imaging during the initial hospital stay, and 3) clinical and imaging follow-up within 6 months. Two neurologists classified patients as either VAD (group A) or non-VAD (group B) by reviewing all the available data at hospital discharge, except HR-MR imaging data. On HR-MR imaging, 2 radiologists searched for signs of acute VAD. The 2 classifications were compared. In case of discordance, CE-MRA follow-up and axial fat-suppressed T1WI, used to obtain supportive evidence for or against VAD, were considered as the standard of reference.

RESULTS: In 4/18 patients in group A, HR-MR imaging did not demonstrate any signs of acute VAD and perivertebral signal-intensity changes were attributed to venous plexus, with an unchanged lumen on follow-up. In 4/17 patients in group B, HR-MRI demonstrated a mural hematoma, with lumen normalization on follow-up CE-MRA.

CONCLUSIONS: Our results encourage the use of HR-MR imaging as a second-line diagnostic tool in the event of suspicion of acute VAD and doubtful findings on standard imaging.

Abbreviations

CE-MRA
contrast-enhanced MR angiography
CI
confidence interval
DSA
digital subtraction angiography
DUS
Doppler ultrasonography examination
DWI
diffusion-weighted imaging
HR
high resolution
NIHSS
National Institutes of Health Stroke Scale
PDWI
proton attenuation− weighted imaging
T1WI
T1-weighted imaging
T2WI
T2-weighted imaging
TEeff
effective echo-time
TOF
time of flight
V2 and V3
the second and third VA segments
VA
vertebral artery
VAD
VA dissection
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American Journal of Neuroradiology: 31 (9)
American Journal of Neuroradiology
Vol. 31, Issue 9
1 Oct 2010
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Added Value of High-Resolution MR Imaging in the Diagnosis of Vertebral Artery Dissection
O. Naggara, F. Louillet, E. Touzé, D. Roy, X. Leclerc, J.-L. Mas, J.-P. Pruvo, J.-F. Meder, C. Oppenheim
American Journal of Neuroradiology Oct 2010, 31 (9) 1707-1712; DOI: 10.3174/ajnr.A2165

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Added Value of High-Resolution MR Imaging in the Diagnosis of Vertebral Artery Dissection
O. Naggara, F. Louillet, E. Touzé, D. Roy, X. Leclerc, J.-L. Mas, J.-P. Pruvo, J.-F. Meder, C. Oppenheim
American Journal of Neuroradiology Oct 2010, 31 (9) 1707-1712; DOI: 10.3174/ajnr.A2165
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