Usefulness of Multidetector Computed Tomography Angiography in Vertebral and Basilar Artery Dissection

ABSTRACT

PURPOSE: Vertebral and basilar artery dissection (VBAD) is difficult to diagnose by conventional computed tomography. However, Multi-detector computed tomography (MDCT) angiography is not only a less invasive diagnostic technique than conventional angiography but also provides high quality images. We assessed clinical manifestations and usefulness of MDCT angiography in VBAD. METHODS: We retrospectively reviewed clinical manifestations, magnetic resonance angiography (MRA) and MDCT angiographic findings of 29 patients who were diagnosed with VBAD by conventional angiography from January 2001 to December 2004. A radiologist reviewed MRA, MDCT axial source images, and three dimensional angiography. RESULTS: The mean patient age was 45.9+/-10.2 years. and 23 (79.3%) patients were less than 55 years old. Eight patients had precipitating factors such as trauma, hyperextension and sports activity. Nineteen patients out of 29 presented with neurological symptoms such as sensory change, dysarthria, ataxia and cerebellar dysfunction. The remaining 10 patients exhibited only nonspecific symptoms such as headache, neck pain and dizziness. Among 19 VBAD patients tested by MRA, 13 patients had positive radiological findings. and 16 of 17 patients evaluated MDCT angiography had positive radiological findings. Therefore, the sensitivities of MRA and MDCT angiography in diagnosing VBAD were 68.4% and 94.1%, respectively. CONCLUSION: VBAD is a cause of stroke at young age. The patients with VBAD may have precipitating factors and can present with nonspecific symptoms without any neurological deficit. MDCT angiography is suitable for use as a rapid diagnostic tool for VBAD.