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Craniocervical artery dissection: diagnosis and follow-up with MR imaging and MR angiography

Fazil M. Gelal, Omer Kitis, Cem Calli, Nilgun Yunten, Berna Dirim Vidinli, Murat Uygur

Med Sci Monit 2004; 10(10): MT109-116

ID: 11777

Published: 2004-10-01

Background:Our aim was to determine the value of MR angiography (MRA) in combination with MRI in the diagnosis and follow-up of craniocervical artery dissections (CCAD) and to document the effectiveness of conservative medical treatment in these patientsMaterial/Methods: In seven patients, six internal carotid artery dissections and two vertebrobasilar artery dissections were studied with 2D and 3D TOF MRA and fat-saturated T1W images. MRA projection images, source images, and T1W images with fat saturation were evaluated for the presence or absence of criteria for dissection.Results: MRA projection images showed narrowing and/or occlusion of lumen in all patients. Dissection flap was identified in 5 of the 8 dissections. Both MRA source images and T1W images with fat saturation were useful in showing the increased external diameter of the dissected vessel and the mural hematoma; although the latter proved to give better results. Almost complete resorption of hematoma and normalization of flow were achieved between 1.5 to 7 months.Conclusions: This study further supports the approach that MRA accompanied by T1W images with fat saturation should be the method of choice in the diagnosis and follow-up of CCAD. Fat-suppressed T1W images improve detection of the mural hematoma, especially in the late sub-acute phase and during follow-up. Conservative medical treatment may be effective, obviating the need for aggressive treatment options.

Keywords: Carotid Arteries - radiography, Adult, Aged, Angiography, Carotid Arteries - surgery, Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Male, Middle Aged