Teaching NeuroImages: Vertebral artery atlas loop dissection in 3D T1 MRI multiplanar reconstruction

A 38-year-old woman presented with left-sided ataxia and a minor ischemic lesion of the left dorsolateral medulla was found on brain MRI. Magnetic resonance angiography was unremarkable (figure 1, A–C). A 3D fat-saturated black-blood 3T T1-weighted sequence (sampling perfection with application-optimized contrast using different flip-angle evolutions [SPACE]) revealed a mural hematoma of the V3 left vertebral artery segment, along the atlas loop (figure 2, A–C, arrows). The excellent volume coverage and mural/luminal distinction characteristics of the SPACE sequence1 allowed the clear depiction of vertebral artery dissection and consequent luminal stenosis, highlighting the need for high-resolution vertebral arteries imaging, particularly in young adult stroke patients.2