Imaging of Carotid Dissection

  • Ryan HakimiEmail author
  • Sanjeev Sivakumar
Neuroimaging (L. Mechtler, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Neuroimaging


Purpose of Review

Here, we describe the four primary imaging modalities for identification of carotid artery dissection, advantages, limitations, and clinical considerations. In addition, imaging characteristics of carotid dissection associated with each modality will be described.

Recent Findings

Recent advances in etiopathogenesis describe the genetic factors implicated in cervical artery dissection. MRI/MRA (magnetic resonance angiography) with fat suppression is regarded as the best initial screening test to detect dissection. Advances in magnetic resonance imaging for the diagnosis of dissection include the use of susceptibility-weighted imaging (SWI) for the detection of intramural hematoma and multisection motion-sensitized driven equilibrium (MSDE), which causes phase dispersion of blood spin using a magnetic field to suppress blood flow signal and obtain 3D T1- or T2*-weighted images. Digital subtraction angiography (DSA) remains the gold standard for identifying and characterizing carotid artery dissections.


Carotid artery dissection is the result of a tear in the intimal layer of the carotid artery. This leads to a “double lumen” sign comprised of the true vessel lumen and the false lumen created by the tear. The most common presentation of carotid artery dissection is cranial and/or cervical pain ipsilateral to the dissection. However, severe neurological sequelae such as embolic ischemic stroke, intracranial hemorrhage, and subarachnoid hemorrhage can also result from carotid artery dissection. Carotid artery dissection can be identified by a variety of different imaging modalities including computed tomographic angiography (CTA), MRI, carotid duplex imaging (CDI), and digital subtraction angiography (DSA).


Carotid artery Craniocervical dissection Computed tomographic angiography Magnetic resonance imaging Magnetic resonance angiography Digital subtraction angiography Carotid Duplex Ultrasonography 



Cervical artery dissection


Carotid Duplex


Carotid Duplex imaging


Computed tomography


Computed tomographic angiography


CT perfusion


Digital subtraction angiography


Fluid attenuation inversion recovery


Glomerular filtration rate


Magnetic resonance


Magnetic resonance angiography


Magnetic resonance imaging


Susceptibility-weighted imaging


Time of flight



Figure 2 courtesy of Dhruvil Pandya, MD

Compliance with Ethical Standard

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Medicine, Neurology DivisionUniv. of South Carolina School of Medicine-Greenville, Greenville Health SystemGreenvilleUSA

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