Interest of 3D Fat-Saturated T1-Weighted Magnetic Resonance Imaging for the Assessment of Cervical Artery Dissection

A 43–years–old woman without any medical history or particular treatment consulted the emergency room for fluctuant headache, developing for five days and resistant to usual treatment. The headache was associated with hypoesthesia of the left part of the face with ptosis. Clinical examination found a slight hypoesthesia in V2 and V3 territories and a Bernard-Horner’s syndrome. Brain magnetic resonance imaging (MRI) showed no brain parenchymal abnormality, especially on diffusion-weighted imaging. Cervical vessels imaging with axial fat suppressed spin echo T1-weighted sequence showed a pre occlusive dissection of petrous segment of the left carotid artery. Study of the cervical portion was suboptimal due to the magnetic susceptibility artifact of a dental implant (Figure 1A). A complementary 3D volumetric fat suppressed spin echo T1-weighted sequence was realized and allowed to partially overcome this artifact and to bring out the extension of this dissection to the cervical part of the carotid artery (Figure 1B, arrow). MR angiography with injection of gadolinium chelates confirmed a tapered stenosis of the left carotid artery (Figure 1C, arrows). The patient was treated with efficient anticoagulant therapy.