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Usefulness of four-dimensional computed tomographic angiography in a vertebral artery dissection case

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Abstract

Discrimination of intramural hematoma from intra-aneurysmal blood flow is a critical issue for determining the necessity of treatment in vertebral artery dissection (VAD) cases. We describe modified four-dimensional computed tomographic angiography (4D-CTA) that is useful for evaluating blood flow in a dissected vertebral artery in a 41-year-old man who was diagnosed as VAD. Magnetic resonance angiography (MRA) showed a growth of intramural hematoma, which was confusingly similar to intra-aneurysmal blood flow. Modified 4D-CTA enabled us to discriminate the intramural hematoma from blood flow because of its fine time and spatial resolution. Modified 4D-CTA may be a substitute for angiography in VAD cases.

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Acknowledgments

We thank T. Morimoto and M. Kaneko for technical help. All data are stored at the Department of Neurosurgery, Shiga Medical Center for Adults, Moriyama, Japan. The authors declare no competing financial interests.

Author information

Correspondence to Masahiro Sawada.

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Informed consent

Informed consent was obtained from the patient included in this case report.

Electronic supplementary material

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Video of conventional 4D-CTA performed 4 days after admission. Vessels were observed in the following order: left VA, basilar artery, distal right VA, and posterior inferior cerebellar artery. (MPG 33480 kb)

Video of a modified 4D-CTA performed 7 days after admission. Clearer images were obtained compared with conventional 4D-CTA (MPG 24998 kb)

Online resource 1

Video of conventional 4D-CTA performed 4 days after admission. Vessels were observed in the following order: left VA, basilar artery, distal right VA, and posterior inferior cerebellar artery. (MPG 33480 kb)

Online resource 2

Video of a modified 4D-CTA performed 7 days after admission. Clearer images were obtained compared with conventional 4D-CTA (MPG 24998 kb)

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Sawada, M., Munemitsu, T. & Hojo, M. Usefulness of four-dimensional computed tomographic angiography in a vertebral artery dissection case. Acta Neurochir 158, 557–560 (2016). https://doi.org/10.1007/s00701-015-2677-0

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Keywords

  • Vertebral artery dissection
  • Four-dimensional computed tomographic angiography
  • Intramural hematoma