ASYMPTOMATIC SPONTANEOUS VERTEBRAL ARTERY DISSECTION IN THE
PRESENCE OF OSTEOPHYTES IN THE TRANSVERSE FORAMEN
OF THE CERVICAL VERTEBRAE
Rostovtseva T.M., Golovin D.A., Lelyuk V.G.
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Purpose. Dissection of vertebral artery is a rare condition, however it takes significant place among the sources of cerebral ischemia in young and middle age patients. Purpose of this article was description of dynamic multimodal instrumental surveillance for the regress of hematoma with the use of imaging methods. Materials and Methods. A 53-year-old female patient with asymptomatic dissection of extracranial segment of vertebral artery was examined with the use of the complex of diagnostic methods including duplex ultrasonography of brachiocephalic arteries and transcranial duplex ultrasonography (scanner Philips Epiq 7G - Philips, USA), transcranial doppler flow monitoring in basilar artery and P2-segments of posterior cerebral arteries (scanner Angiodin Universal, «NPF BIOSS», Russia), MRI of the neck with MR-angiography (scanner Discovery 370 3Т, GE, USA), MDCT of the neck with MDCT-angiography (128-slice CT scanner Optima, GE, США). Results. In this article we describe multimodal clinical and diagnostic monitoring of natural history of asymptomatic dissection of vertebral artery with the attemp of clarification the leading cause of its origin. Conclusion. Dissections of vertebral arteries may be symptomatic and completely regress over time, for this reason its true incidents could be underestimated. Complex of imaging methods should be used for the initial diagnosis and follow up with due regard of the stage of the pathological process and limitations of diagnostic methods. |
Federal Center for Cerebrovascular Pathology and Stroke. Russia. |
Keywords: vertebral artery dissection, osteophytes, false lumen, mural hematoma, multimodal monitoring, MRI, CT, duplex ultrasonography, microembolus detection, natural history of dissection, brachiocephalic arteries.
Corresponding author: Rostovtseva T.M., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript .
For citation: Rostovtseva T.M., Golovin D.A., Lelyuk V.G. Asymptomatic spontaneous vertebral artery dissection in the presence of osteophytes in the transverse foramen of the cervical vertebrae. REJR 2020; 10(2):252-265. DOI:10.21569/2222-7415-2020-10-2-252-265.
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Received: 02.02.20 Accepted: 03.03.20
Exploring the possibilities of Ultrasonic Shear Wave Elastography (SWE) in controlling the formation of bone calluses at different stages of its development.
Material and methods. A study of 51 patients (29 men, 22 women from 17 to 65 years) with fractures of long tubular bones of the upper and lower limbs was conducted. Ultrasound tests were performed on the SuperSonic Aixplorer (France) device with an assessment of tissue stiffness in the kPa and the use of multifrequency probes 2-15 MHz. In the area of the fracture scanned bone corn, surrounding soft tissues and vessels, excluded interposition. The formation of bone calluses was studied at different stages of its development, from 0-7 days to 6 months.
Results. According to the SWE, the most intensive increase in bone calluses is in the first 1.5 months after the fracture, followed by the build-up of bone calluses. For each stage of bone callos formation determined sensitivity, specificity of the method of SWE.
Discussion. The use of the SWE method to control the formation of bone calluses is possible from the first days after bone fracture. The stiffness of bone calluses at SWE is determined in the kPa. Ultrasound also allows you to study the condition of bone fragments, surrounding tissues and vessels. Conducting ultrasound with the use of SWE, dopplerography allows in dynamics to trace the formation of bone calluses in all three stages of its development.
Conclusion. SWE wave allows to determine the stiffness of the bone calluses in the dynamics, starting from the first days after the fracture and to its complete formation. SWE implements a new approach to assess the stiffness of bone calluses, which allows to get accurate quantitative results in real time. The sensitivity and specificity of the SWE in determining the stiffness of bone calluses is highest in the first – connective tissue stage of its formation (94% and 90% respectively).