Utility of cone-beam computed tomography angiography for the assessment of vertebral artery dissection. (February 2018)

• Record Type: Journal Article
• Authors: Fukuda, Kenji; Higashi, Toshio; Okawa, Masakazu; Matsumoto, Juntaro; Takano, Koichi; Inoue, Tooru
• Is Part Of: Journal of clinical neuroscience. Volume 48(2018)
• Page Start: 76
• Page End: 80
• Publication Date: 2018-02
• Subjects: Cone-beam computed tomography angiography -- Vertebral artery dissection -- Intimal flap/double lumen -- Wall thickening/intramural hematoma -- Enhancement of outer wall; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2017.11.010
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Cone-beam CT-angiography (CBCT-A) provides the accurate vasculature clearly with high spatial resolution. CBCT-A is the most superior modality to detect intimal flap/double lumen in vertebral artery dissection (VAD). Wall thickening and enhancement of outer vessel wall are identified in some cases by CBCT-A. CBCT-A is considered beneficial for accurate diagnosis of VAD, compared with 2D-DSA, 3D-DSA, CTA, and MRI. Abstract: Vertebral artery dissection (VAD) has been recognized as a cause of headache and stroke. Accurate evaluation of dissection using several modalities such as catheter-based angiography, CT angiography (CTA), and magnetic resonance imaging (MRI) is essential for subsequent management. The aim of this retrospective study is to compare cone-beam computed tomography angiography (CBCT-A) with other image modalities for the evaluation of the detailed structures of VAD. Twenty-five consecutive cases identified as having VAD were included. They underwent catheter-based angiography (2D-digital subtraction angiography [DSA], 3D-DSA, and CBCT-A), CTA, and MRI for the diagnosis of VAD. CBCT-A was performed following conventional angiography. Dissecting lesions were evaluated for the presence of intimal flap/double lumen, wall thickening, and enhancement of outer wall. This study results showed that CBCT-A was the most superior modality to detect intimal flap/double lumen (found in 56% of the cases) due to its high spatial resolution. MRI was superior for the assessment of wall thickening as an intramural hematoma in 76% of the cases. However, wall thickening was detected in 44% of cases using CBCT-A. In 5 cases, enhancement of outer wall was identified only in CBCT-A. In conclusion, CBCT-A provides detailed luminal and wall morphology of VADs. CBCT-A is useful for the accurate diagnosis of VADs.