Magnetic Resonance Angiography Source Images of Vertebral-artery Dissection

A 62-year-old man was admitted to our hospital with a brain infarction in the right medulla. On the first day, he was diagnosed with a vertebral artery dissection, based on the findings from conventional angiography, which showed an irregular stenosis associated with a pseudoaneurysm of the right vertebral artery (Picture 1). This finding on classical angiography is called the pearl and string sign (1). A false lumen (white arrow) was obscurely observed on the right vertebral artery by magnetic resonance angiography (MRA) on Day 10 (Picture 2). However, an MRA source image was able to more clearly show a double lumen, consisting of the true lumen (white arrowhead) and false lumen (white arrow) (Picture 3). Although the double lumen sign is often observed on conventional angiography (2), very few reports have described it on MRA source images. MRA source images might aid in the diagnosis of artery dissection.