Monday 9 January 2012

Vertebral artery thrombosis

On MR Angio, non visualization of a vessel or a part of vessel needs careful interpretation as it can be due to many reasons right from thrombotic occlusion of vessel, absent vessel as a part of normal anatomical variation or a technical error while doing post processing of raw images of 3D TOF sequences by using add vessel technique.
So diagnosis of vessel thrombosis or passing it off as a normal anatomical vessel should not be solely based on MR Angiography findings.
The diagnostic dilemma occur more so when there is no infarct in corresponding vascular territory.
This problem is most common with vertebral where one of the vertebral is not visualised. Opposite vertebral continues as basilar. In such cases we can take help of other routine parenchymal sequences like FLAIR and T2*GRE.

In above case, thrombosed distal most portion of right intra cranial vertebral near formation of basilar show a focal flow loss on MR Angio, the corresponding portion show an abnormal low signal on T2*GRE and high signal on FLAIR implies to thrombus. 

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