Which imaging modality is the most accurate in vertebral artery dissection diagnosis? Pei Wen Tammy Kwa, Sarah Moore, Paul Ryan, Kate Somers Introduction An arterial dissection is said to occur when the structural integrity of an arterial wall is compromised, permitting blood to collect between layers of the vessel wall to form an intramural haematoma. Arterial dissection is a common cause of stroke in the young, although it may occur at any age. Vertebral artery dissection (VAD) most often occurs in the cervical transverse processes of C6 to C2 (V2 segment) or the extracranial segment between the transverse process of C2 and the foramen magnum at the base of the skull (V3 segment)1. Dissection typically occurs following trauma or may arise spontaneously2. Certain connective tissue and vascular disorders have been …show more content…
The relative absence of recent data reflects the lack of enthusiasm for the use of this imaging modality for VAD in present day. More recent studies suggest that ultrasound is not necessary for the diagnosis of VAD but may offer more information on the possible development of stroke16. These studies suggest that ultrasound could be put to better use in a follow-up scenario – monitoring progress and recanalization. With regard to the of the pitfalls of ultrasound diagnosis of VAD, investigators found that ultrasonography is made difficult by the course of the VA as it becomes invisible to ultrasound as through the foramen transversarium14 – making it impossible to effectively image the whole course of the VA. VAD has been seen to affect all sections of the VA11-15. However, wall abnormalities in some sections of the VA are seldom depicted on ultrasound. Furthermore, although ultrasound can successfully identify stenosis in certain areas of the VA, it cannot differentiate between stenosis due to a VAD and stenosis due to atherosclerotic