The Use of 3D FS T1 Sequence to Diagnose Cervical Arterial Dissections in Peripartum Populations: A Case Series

Cervical artery dissections (CAD) are the leading cause (20-25%) of ischemic stroke in young and middle age adults. One particular population that is at increased risk is the peripartum woman. Imaging plays a crucial role for the initial diagnosis and follows up of CAD. Although conventional angiography is the gold standard for evaluating the arterial lumen, it doesn't offer information about the vascular wall and is unable to detect mural hematomas, thus increasing false negative rates. On the contrary, MRI imaging provides direct visualization of the mural hematoma with greater sensitivity and specificity than CT. MRI also facilitates the detection of luminal abnormalities and cerebral ischemic events resulting from CAD. Currently the 2D fat saturated (FS) T1 weighted sequence spin echo (SE) is one of the main tools in the protocol to study cervical artery dissections, yet this sequence has many limitations. Some research studies have demonstrated the advantages of the 3D T1 FS SPACE sequence(such as faster speed of acquisition, greater field of coverage and superior spatial resolution) when compared to the 2D FS T1 SE sequence. We present 3 cases of recently postpartum females who presented with neck pain, headache, and several other neurologic symptoms including stroke like symptoms and were found to have CADs on 3D FS T1 sequence MRI that were not diagnosed using conventional CT angio or ultrasound. We encourage clinicians to implement the 3D FS T1 SPACE sequence in their workup for optimal diagnosis of cervical artery dissections in the pregnant/peripartum population that present with neck pain, headache, and other neurologic symptoms, which will guide prompt treatment subsequently decreasing the rate of morbidity and mortality in this high risk population.