Identification of Cervical Artery Dissections: Imaging Strategies and Literature Review

AbstractPurpose of ReviewVertebral or carotid artery dissections, collectively called cervical artery dissections (CeADs), are uncommon, regularly missed vascular injuries. They are associated with major trauma, but also occur spontaneously or with relatively minor trauma. Diagnosis hinges on imaging identification. Previously, catheter angiogram was the gold standard, but currently, there is no consensus on the initial imaging study.Recent FindingsComputer tomography angiography (CTA) is the most common initial study for CeAD, but can fail to identify some dissections. MRI/MRA provides better images and is preferred in the pediatric population, but misses some pathology. Newer MRI/MRA techniques are improving diagnostic accuracy for CeADs. Ultrasound is increasingly used for screening and monitoring. Treatment focuses on preventing thromboembolic events with antiplatelet or anticoagulation medications, though neither appears superior based on the CADISS trial.SummaryNo imaging study is the best initial CeAD study. MRI/MRA is preferred for pediatric patients. Ultrasound has good specificity for CeAD identification with caveats.
Source: Current Emergency and Hospital Medicine Reports - Category: Emergency Medicine Source Type: research