[Cervical arteries dissection: diagnostic Color Doppler US criteria at the acute phase]

Abstract

Purpose: To estimate the value of duplex color-coded ultrasonography in the initial diagnosis of acute cervical artery dissection.

Material and method: Retrospective study of 31 patients, mean age 45, sex ratio=1, referred for clinical suspicion of cervical artery dissection, confirmed by MRI. 46 dissected arteries were imaged. Ten patients presented multiple dissections. The evaluated sonographic diagnostic criteria were the direct signs of intra-mural hematoma: localized increased diameter of the artery, narrowed lumen, hypo and/or isoechoic intra-mural hematoma, intimal flap. The associated criteria studied were: the location of intra-mural hematoma and in case of an occlusion, the dissection of an other artery.

Results: We analyzed separately the arterial segments visualized in B-mode ultrasound (supra-bulbar internal carotid artery, vertebral artery from V0 to V3) and the arterial segments evaluated only by pulsed Doppler (intrapetrosal carotid artery, V3-V4 of the vertebral artery). With the above criteria, on arterial segments visualized in B-mode ultrasound, the diagnosis of dissection was done in 83% of cases during the initial examination but in only 30% of the arterial segments non visualized on ultrasonography.

Conclusion: The direct signs of intra-mural hematoma on internal carotid and vertebral segments imaged by B-mode ultrasonography have a good sensitivity. Because results were compared to MRI, the specificity could not be assessed. In case of occlusion of an artery, multiple dissections are a strong argument for the diagnosis.