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

Example of discordance between the standard approach and HR-MR imaging. Suspicion of traumatic right acute VA dissection in a 25-year-old woman with sudden neck pain and dizziness, without stroke. DUS findings were consistent with a right vertebral mural hematoma (not shown). A, On CE-MRA, note irregularity of the right V2 segment (arrow). B, On axial fat-suppressed cervical T1WI, note hyperintense crescentic thickening of the right VA, associated with a slight crescentic hyperintensity of the left VA (arrows). C, On axial high-resolution T1WI, obtained 24 hours later, the crescentic hyperintense mural thickening is no longer present, leading to the diagnosis of inflow enhancement of the hypertrophic venous structure. D, On 6-month follow-up CE-MRA, the lumen of the right VA remains unchanged (arrow).

Example of discordance between the standard approach and HR-MR imaging. Suspicion of spontaneous acute dissection in a 40-year-old woman with left neck pain and laterobulbar acute stroke. A, On CE-MRA, note occlusion of the right VA and stenosis (arrow) of the left V3 segment. B, On axial fat-suppressed cervical T1WI, note inconclusive crescentic hyperintense mural thickening of the left VA (arrow) and a hyperintense occluded lumen of the right V3 segment (double arrow). DUS did not demonstrate any mural hematoma (not shown). C, On axial high-resolution fat-suppressed T2WI, obtained 24 hours later, note crescentic hyperintense mural thickening (arrow). D, On 5-month follow-up CE-MRA, note clear improvement of the left V3 stenosis. This favors the diagnosis of VAD.