Vertebrobasilar system computed tomographic angiography in central vertigo

Abstract

The incidence of vertigo in the population is 20% to 30% and one-fourth of the cases are related to central causes. The aim of this study was to evaluate computed tomography angiography (CTA) findings of the vertebrobasilar system in central vertigo without stroke.CTA and magnetic resonance images of patients with vertigo were retrospectively evaluated. One hundred twenty-nine patients suspected of having central vertigo according to history, physical examination, and otological and neurological tests without signs of infarction on diffusion-weighted magnetic resonance imaging were included in the study. The control group included 120 patients with similar vascular disease risk factors but without vertigo. Vertebral and basilar artery diameters, hypoplasias, exit-site variations of vertebral artery, vertebrobasilar tortuosity, and stenosis of ≥50% detected on CTA were recorded for all patients. Independent-samples t test was used in variables with normal distribution, and Mann-Whitney U test in non-normal distribution. The difference of categorical variable distribution according to groups was analyzed with χ and/or Fisher exact test.Vertebral artery hypoplasia and ≥50% stenosis were seen more often in the vertigo group (P = 0.000, <0.001). Overall 78 (60.5%) vertigo patients had ≥50% stenosis, 54 (69.2%) had stenosis at V1 segment, 9 (11.5%) at V2 segment, 2 (2.5%) at V3 segment, and 13 (16.6%) at V4 segment. Both vertigo and control groups had similar basilar artery hypoplasia and ≥50% stenosis rates (P = 0.800, >0.05).CTA may be helpful to clarify the association between abnormal CTA findings of vertebral arteries and central vertigo.This article reveals the opportunity to diagnose posterior circulation abnormalities causing central vertigo with a feasible method such as CTA.

Figure 1

A 72-year-old-man with vertigo. A 50% stenosis is seen due to a noncalcified plaque on the origin of right vertebral artery on the curved multiplane reconstructed computed tomographic angiography.

Figure 2

A 68-year-old-woman with vertigo. Right vertebral artery hypoplasia is seen on the 3D volume rendered computed tomographic angiography.

Figure 3

Vertebral artery segments are shown on the 3D volume rendered coronal and sagittal CTA images. CTA = computed tomography angiography.

Figure 4

A 65-year-old-man with vertigo. Basilar artery hypoplasia is seen on the sagittal (A) and coronal (B) maximum-intensity projection multiplane reconstructed computed tomographic angiography images.

Figure 5

Sagittal oblique maximum-intensity projection (MIP) image shows the kinking and tortuosity of the V1 segment of left vertebral artery.

Figure 6

3D volume rendered coronal (A) and curved multiplanar reconstruction coronal (B and C) images show right vertebral artery stenosis associated with left vertebral artery hypoplasia.

Figure 7

(A and B) Curved multiplanar reconstructed coronal CT images show bilateral hypoplastic vertebral arteries of a vertigo patient. CT = computed tomography.