Fig 4.

VW-MR imaging to diagnose intracranial arterial dissection with minimal luminal narrowing. A 57-year-old man presented to the emergency department with severe headache and neck pain for 1 week. 3D rendering of a CTA shows smooth narrowing of the intradural segment of the right vertebral artery (A, arrows). This angiographic appearance was considered most likely within the range of normal because the vertebral artery is commonly narrower beyond the posterior inferior cerebellar artery origin, but a bit equivocal. Coronal (B) and axial (C) nonenhanced T1-weighted VW-MR imaging shows eccentric intense hyperintensity (B and C, arrows) in the wall of the right vertebral artery, consistent with recent arterial dissection.