MRI-GUIDED AND MRA-GUIDED THERAPY OF CAROTID AND VERTEBRAL ARTERY DISSECTIONS

A high sensitivity and specificity has been shown for magnetic resonan ce imaging (MRT) and angiography (MRA) in the diagnosis of internal ca rotid (ICAD) and vertebral (VAD) artery dissections, where arteriograp hy has been and still is the gold standard. Five patients (three with ICAD, two with VAD; age range 42-56 years) are presented, in whom diag nosis and follow-up management were exclusively based on non-invasive measures. In all patients, MRI demonstrated a typical intramural hemat oma and MRA in 3D phase contrast technique showed loss or diminished f low. After anticoagulation (heparin) for 3 to 4 weeks follow-up, MRI s howed a regression of the mural hematoma and MRA revealed reperfusion or improvement of flow. Depending on the extent of MRI-/MRA-pathology, three patients were put on antiplatelet therapy and two on Coumadin u ntil normalization of MRI and MRA findings, which are assessed in 3-mo nths intervals. We suggest, that with, (I) a suspicious history, sympt oms and signs for cervical artery dissection (CAD), (II) typical MR-fi ndings proven to indicate CAD, (III) improving or resolving at follow- up, (IV) in unusual location for atherosclerotic involvement, (V) in t he absence of coexisting atherosclerotic lesions, the diagnosis has no t to be confirmed with conventional arteriography. Therefore, safe MRI - and MRA-guided anticoagulation and antiplatelet therapy during seria l follow-up measurements are possible. (C) 1997 Elsevier Science B.V.