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Dissection on Routine Cervical MRI – An Important Finding to Recognize 2012

General Spine

Chris, Buckle
Colin, Poon, MD, Non ASSR Member
Ken, Goldberg, MD, Non ASSR Member
William, Ankembrandt, MD, Non ASSR Member
Joel, Meyer, MD, Non ASSR Member
Bojan, Petrovic, Non ASSR Member

Poster

Purpose

Imaging findings of cervico-cephalic dissection are present on routine cervical MR scans but can be a blind spot in the final interpretation . The purpose of this exhibit is to review the experience of our institution identifying dissection in situations when the exam is not optimally protocoled to detect it, such as on routine Cervical MR.

Methods & Materials

A retrospective review of 4 cases of cervical dissection on routine cervical MRI (T1 axial and sagittal, sagittal PD and T2 and axial T2*(gradient echo) scans) identified over a 2 year period. Cervico-cephalic dissection was not considered by referring physician. Images were reviewed by two experienced neuroradiologists to determine which sequences in which orientation provided the best visualization. Additional sequences (example fat saturation post contrast) were noted where obtained. Clinical history was recorded.

Results

In all cases, the dissection was evident on more than one sequence, in more than one image. 50% of cases were best seen on the sagittal images manifested by a loss of normal flow void with subintimal methemoglobin extended intracranially and 50% were best seen on axial images , manifested by the crescent sign. All patients presented with acute pain without focal neurological symptoms. Identification of vascular abnormalities on routine cervical MR prompted further evaluation and early treatment. None of the patients developed posterior circulation infarction.

Conclusion

It is important to evaluate the vertebral flow voids on every cervical MR. Dissection is not uncommon and has non specific symptoms that overlap significantly with those of degenerative changes. Awareness of imaging findings that suggest arterial dissection on routine cervical spine MR can significantly alter clinical management and effectively reduce the risk of neurologic complication associated with cervicocephalic dissection.

References/Financial Disclosures

1. Diagnosis and outcome of cervical artery dissection. Divjak I, Slankamenac P, JoviÄ