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Craniocervical Arterial Dissection: Spectrum of Imaging Findings and Differential Diagnosis¹

¹ From the Department of Radiology, Fondation Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75674 Paris cedex 14, France (M.H.R., V.M., S.G., L.D., M.Z.); and the Department of Neuroradiology, Hôpital Pitié-Salpétrière, Paris, France (S.G.). Recipient of an Excellence in Design award for an education exhibit at the 2007 RSNA Annual Meeting. Received February 11, 2008; revision requested March 17 and received April 21; accepted April 28. Supported in part by the Centre d’Exploration Vasculaire, Paris, France. All authors have no financial relationships to disclose. Address correspondence to M.H.R. (e-mail: mathieurodallec{at}hotmail.com).

Craniocervical artery dissection is a potentially disabling yet probably underrecognized condition that often occurs in young and middle-aged adults. Accurate and prompt diagnosis of this condition is crucial because timely and appropriate therapy can significantly reduce the risk of stroke and long-term sequelae. Because of the great diversity in the clinical features of craniocervical artery dissection, imaging plays a primary role in its diagnosis. The increased diagnosis of this disorder in the past two decades can be attributed to an increased awareness of the clinical manifestations of internal carotid artery and vertebral artery dissection and to use of noninvasive diagnostic imaging techniques. To achieve an accurate diagnosis of craniocervical artery dissection, it is important to be familiar with its pathologic features (intimal tear, intramural hematoma, and dissecting aneurysm); the spectrum of imaging findings at color duplex ultrasonography, computed tomographic angiography, magnetic resonance (MR) imaging with MR angiography, and conventional angiography; and potential pitfalls in image interpretation.

© RSNA, 2008