Vol.:(0123456789) 1 3 Journal of Medical Ultrasonics https://doi.org/10.1007/s10396-018-0901-2 REVIEW ARTICLE Color Doppler ultrasonography is a reliable diagnostic tool in the diagnosis of extracranial vertebral artery dissections Cengiz Yılmaz 1  · Feride Fatma Gorgulu 1  · Fatma Yasemin Oksuzler 1  · Muhammet Arslan 2  · Mahmut Oksuzler 3  · Sakir Ozgur Keskek 4  · Ayse Selcan Koc 1 Received: 9 March 2018 / Accepted: 13 August 2018 © The Japan Society of Ultrasonics in Medicine 2018 Abstract The purpose of this study was to evaluate the role of color Doppler sonography (CDS) in the diagnosis of extracranial verte- bral artery dissections (EVADs). One hundred and fifty consecutive patients (age range 21–51 years, mean 44 years) with a clinical suspicion of vertebral artery dissection (VAD) were included in this study. All patients underwent CDS of vertebral arteries as the first-line imaging modality. Cervical T1-weighted fat-saturated axial MR images served as the gold standard. Of the 150 patients with a clinical suspicion of VAD, 27 patients were ultimately diagnosed with EVADs based on fat-saturated T1-weighted MR imaging. MR imaging was considered positive when crescentic hyperintensity (methemoglobin signal) was demonstrated at the wall of the vertebral artery. CDS was positive in 21 of these 27 patients and revealed either intramural hematoma or a dissecting membrane with two lumina. The most frequent site of involvement was the V1 to proximal V2 segment. The sensitivity, specificity, and positive and negative predictive values of CDS in the diagnosis of EVADs were 77.8, 98.4, 91.3, and 95.3%, respectively. CDS is a reliable diagnostic tool in the diagnosis of EVADs. Keywords Color Doppler sonography · Vertebral artery dissection Introduction Vertebral artery dissection (VAD) is one of the most fre- quent causes of stroke in patients under 45 years of age. The most common symptoms are dizziness, vertigo, headache, and neck pain. Stroke is also common, especially in extrac- ranial vertebral artery dissections (EVADs) [1]. Prompt diagnosis is essential to avoid serious neurologic complica- tions and to initiate proper treatment. Although conventional angiography is considered the gold standard, the invasive nature of angiography precludes its use as a primary diag- nostic tool [2]. Studies that examined the presence of EVADs by color Doppler sonography (CDS) are limited [4, 5]. The aim of this study was to evaluate the role of CDS in the diagnosis of EVADs. Materials and methods One hundred and fifty consecutive patients with a clinical suspicion of VAD were included in this study. Twenty- seven (14 men and 13 women, aged 21–51 years, mean age 39.5 ± 4.6 years) of these 150 patients were ultimately diagnosed with EVADs based on fat-saturated T1-weighted cervical magnetic resonance imaging (MRI). Patients with MRI findings compatible with intracranial VAD were not included. Data were collected within a period of 7 years. Informed consent was obtained from each patient. Patients with a clinical suspicion of VAD were referred from the neurologic ward or emergency department. All patients with EVADs underwent both MRI and CDS. Examination of the cervical vertebral artery (VA) was performed accord- ing to the method described by Lu et al. [3]. The segment between C5 and C6 was first identified. Then, the artery was * Ayse Selcan Koc drayseselcankoc@gmail.com 1 Department of Radiology, University of Health Sciences, Adana Health Practice and Research Center, Adana, Turkey 2 Department of Radiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey 3 Department of Radiology, Medline Hospital, Adana, Turkey 4 Department of Internal Medicine, University of Health Sciences, Adana Health Practice and Research Center, Adana, Turkey