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Imaging of Spontaneous and Traumatic Cervical Artery Dissection

Comparison of Typical CT Angiographic Features

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Abstract

Introduction

Cervical artery dissection (CAD) is an important etiology of ischemic stroke and early recognition is vital to protect patients from the major complication of cerebral embolization by administration of anticoagulants. The etiology of arterial dissections differ and can be either spontaneous or traumatic. Even though the historical gold standard is still catheter angiography, recent studies suggest a good performance of computed tomography angiography (CTA) for detection of CAD. We conducted this research to evaluate the variety and frequency of possible imaging signs of spontaneous and traumatic CAD and to guide neuroradiologists’ decision making.

Methods

Retrospective review of the database of our multiple injured patients admitted to the Department of Trauma, Hand, and Reconstructive Surgery of the University Hospital Münster in Germany (a level 1 trauma center) for patients with traumatic CAD (tCAD) and of our stroke database (2008–2015) for patients with spontaneous CAD (sCAD) and CT/CTA on initial clinical work-up. All images were evaluated concerning specific and sensitive radiological features for dissection by two experienced neuroradiologists. Imaging features were compared between the two etiologies.

Results

This study included 145 patients (99 male, 46 female; 45 ± 18.8 years of age), consisting of 126 dissected arteries with a traumatic and 43 with spontaneous etiology. Intimal flaps were more frequently observed after traumatic etiology (58.1% tCADs, 6.9% sCADs; p < 0.001); additionally, multivessel dissections were much more frequent in trauma patients (3 sCADs, 21 tCADs) and only less than half (42%) of the patients with traumatic dissections showed cervical spine fractures.

Conclusion

Neuroradiologists should be aware that intimal flaps and multivessel dissections are more common after a traumatic etiology. In addition, it seems important to conduct a CTA in a trauma setting, even if no cervical spine fracture is detected.

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Authors and Affiliations

  1. Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany

    Peter B. Sporns, Thomas Niederstadt, Walter Heindel & Uta Hanning

  2. Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany

    Michael J. Raschke & René Hartensuer

  3. Department of Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany

    Ralf Dittrich

  4. Department of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Uta Hanning

Authors
  1. Peter B. Sporns
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  2. Thomas Niederstadt
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  3. Walter Heindel
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  4. Michael J. Raschke
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  5. René Hartensuer
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  6. Ralf Dittrich
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  7. Uta Hanning
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Corresponding author

Correspondence to Peter B. Sporns.

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Conflict of interest

P. Sporns, T. Niederstadt, W. Heindel, M. J. Raschke, R. Hartensuer, R. Dittrich, U. Hanning declare that they have no competing interests.

Ethical standards

This retrospective study was approved by the Ethics Committee of the University Münster and the Westfalian Chamber of Physicians, Münster, Germany. All study protocols and procedures were conducted in accordance with the Declaration of Helsinki.

Additional information

Both senior authors (R. Dittrich and U. Hanning) contributed equally.

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Sporns, P.B., Niederstadt, T., Heindel, W. et al. Imaging of Spontaneous and Traumatic Cervical Artery Dissection. Clin Neuroradiol 29, 269–275 (2019). https://doi.org/10.1007/s00062-018-0666-4

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  • DOI: https://doi.org/10.1007/s00062-018-0666-4

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