From the Departments of Radiology (S.B.L., M.B., K.R.), Neurosurgery and Pediatrics (A.R.), and Pediatrics-Child Neurology (B.P.), Children's Healthcare of Atlanta, Emory University, Atlanta, GA; and Departments of Radiology (A.S., S.P.) and Pediatrics (L.C.J.), Vanderbilt University Medical Center, Monroe Carell Jr Children's Hospital, 2200 Children's Way, Nashville, TN 37323.
Radiographics. 2023 Dec;43(12):e230107. doi: 10.1148/rg.230107.
Vertebral artery dissection (VAD) is a common cause of a rare condition, pediatric posterior circulation arterial ischemic stroke (PCAIS). VAD is clinically important due to the risk of multifocal and continuing infarcts from artery-to-artery thromboembolism, with the potential for occlusion of arteries that perfuse the brainstem. Early diagnosis is important, as recurrent stroke is a common effect of VAD in children. Although the relative efficacies of different treatment regimens for VAD in children remain unsettled, early initiation of treatment can mitigate the risk of delayed stroke. Clinical diagnosis of PCAIS may be delayed due to multiple factors, including nonspecific symptoms and the inability of younger patients to express symptoms. In fact, subacute or chronic infarcts are often present at initial imaging. Although the most common cause of isolated PCAIS is VAD, imaging of the cervical arteries has been historically underused in this setting. Cervical vascular imaging (MR angiography, CT angiography, and digital subtraction angiography) for VAD must be optimized to detect the sometimes subtle findings, which may be identified at initial or follow-up imaging. Osseous variants of the craniocervical junction and upper cervical spine and other extrinsic lesions that may directly injure the vertebral arteries or lead to altered biomechanics have been implicated in some cases. The authors review characteristic imaging features and optimized imaging of VAD and associated PCAIS and related clinical considerations. Identification of VAD has important implications for evaluation, treatment, and imaging follow-up, as this condition may result in progressive arteriopathy and recurrent stroke. RSNA, 2023 Supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
椎动脉夹层（vertebral artery dissection，VAD）是小儿后循环动脉缺血性脑卒中（posterior circulation arterial ischemic stroke，PCAIS）这一罕见病症的常见病因。由于存在动脉到动脉血栓栓塞导致多灶性和持续性梗死的风险，以及可能导致供应脑干的动脉闭塞，VAD 具有重要的临床意义。早期诊断很重要，因为 VAD 是儿童复发性脑卒中的常见原因。尽管儿童 VAD 不同治疗方案的相对疗效仍未确定，但早期开始治疗可以降低脑卒中延迟的风险。由于多种因素，包括非特异性症状和较年轻患者无法表达症状，小儿 PCAIS 的临床诊断可能会延迟。事实上，在初始影像学检查时，经常存在亚急性或慢性梗死。虽然孤立性 PCAIS 最常见的病因是 VAD，但在这种情况下，颈椎血管的影像学检查在历史上一直未得到充分利用。为了检测有时很细微的发现，VAD 的颈椎血管成像（磁共振血管造影、CT 血管造影和数字减影血管造影）必须进行优化，这些发现可能在初始或随访影像学检查中被识别。颅颈交界区和颈椎上段的骨结构变异以及可能直接损伤椎动脉或导致生物力学改变的其他外在病变，在某些情况下与 VAD 有关。作者回顾了 VAD 及相关 PCAIS 的特征性影像学表现和优化的影像学检查，并讨论了相关的临床注意事项。VAD 的识别对评估、治疗和影像学随访具有重要意义，因为这种情况可能导致进行性血管病变和复发性脑卒中。RSNA，2023 补充材料可在本文中获得。本文的测验问题可通过在线学习中心获得。
