Usefulness of high-resolution vessel wall magnetic resonance imaging for the diagnosis of vertebral artery dissection

Purpose: We aimed to evaluate the usefulness of high-resolution vessel wall magnetic resonance imaging (HR vw-MRI) in diagnosing vertebral artery dissection (VAD). Methods: We retrospectively evaluated data from 44 patients who underwent HR vw-MRI, conventional MR, or MR angiography. Patients with a history of trauma were excluded. One experienced stroke neurologist diagnosed the patients with either VAD or non-VAD. HR vw-MRI data were retrospectively evaluated by a neuroradiologist for the presence of acute signs of dissection (crescent high-signal intramural hematoma, double lumen, or intimal flap). When one or more signs of acute dissection were observed on imaging, VAD signs were considered positive. The HR vw-MRI findings were compared between the two groups (VAD and non-VAD). MR angiographic shapes of the VAD were divided into three subtypes: (a) occlusion, (b) stenosis, and (c) dilation and stenosis. All 44 patients (male-to-female ratio, 35:9; mean age, 54 years; [range, 23-85 years]) were categorized into VAD (50%) and non-VAD (50%) groups. Results: HR vw-MRI revealed one or more acute signs of VAD (intramural hematoma, intimal flap, or double lumen) in 20 of the 22 patients in the VAD group and in four of the 22 patients in the non-VAD group. Twenty-seven VAD lesions were identified in 24 patients using HR vw-MRI. Type (a) included 14 lesions, type (b) 10 lesions, and type (c) three lesions. Conclusion: HR vw-MRI can be a useful and noninvasive diagnostic tool for symptomatic VAD.