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

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 (CLAD) and to document the effectiveness of conservative medical treatment in these patients. Materials/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.