Learning objectives
To review carotid dissection,
the imaging findings on CT,
MRI and angiography and to show examples.
Background
The carotid dissection consists in a leakage of blood to the middle layer through an intimal flap of the arterial wall or,
alternatively,
media haemorrhage from vasa vasorum.
Blood usually enters the media at the site of intimal injury,
and the dissection usually extends cranially in the same direction as the bloodstream.
The intramural hematoma usually compresses the true lumen of the artery and causes enlargement of the external diameter of the artery.
The aetiology can be traumatic (blunt or penetrating injury) or spontaneous such...
Imaging findings OR Procedure details
Multidetector computed tomography (MDCT) angiography allows multiplanar reconstructions and volume rendering images and it is noninvasive.
The signs found in carotid dissection are:
A narrow eccentric lumen,
Fig. 1 Fig. 2
crescent-shaped mural thickening,
Fig. 3
enlargement of the overall vessel diameter,
Fig. 4
hypodense line separating both lumens (intimal flap),
Fig. 5
stenosis,
Fig. 2
occlusion,
aneurysm formation,
thin rim-like enhancement.
MRI allows a wide variety of sequences and modalities to asses carotid dissection.
We have the cross sectional T1WI,
T2WI and PDWI which...
Conclusion
The carotid dissection is a major cause of stroke in young patients that may result in significant morbidity without treatment (risk of stroke and long-term sequelae).
It is important for radiologist be acquainted with findings and sources of error to achieve the correct diagnosis with non-invasive techniques.
References
Vertinsky A.T,
Schwartz N.E,
Fischbein N.J,
Rosenberg.
J, Albers,
G.W,
Zaharchuk G.
Comparison of Multidetector CT Angiography ang MR Imaging of cervical artery dissection.
AJNR 2008 29: 1753-1760
SchievinkWI.
Spontaneous dissection of the carotid and vertebral arteries.N Engl J Med 2001;344:898 –906.
Flis CM,
Jager HR,
Sidhu PS.
Carotid and vertebral artery dissections: clinicalaspects,
imaging features and endovascular treatment.
Eur Radiol 2007; 17: 820 –34
Rubinstein SM,
Peerdeman SM,
van Tulder MW,
Riphagen I,
Haldeman S.
A.
Systematic review of the risk factors for cervical...