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Age: 21

Sex: Male

Indication: Trauma, CT showed fractures of the left occipital condyle, right C1 and C2 lateral masses, and right C3 transverse process

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Case #9


Findings

  • Known fractures are not well demonstrated by MRI
  • Extensive prevertebral soft tissue thickening and T2/STIR signal hyperintensity extending from the craniocervical junction to the level of C5
  • T2/STIR signal hyperintensity in the C4-C5, C5-C6, and C6-C7 interspinous ligaments with overlying T2/STIR signal hyperintensity in the posterior paraspinal soft tissues at these levels
  • Mild STIR signal hyperintensity in the supraodontoid space and right atlantooccipital joint
  • Abnormal flow-related signal in the right internal carotid artery from the level of C3 through the skull base with circumferential mural T2 signal hyperintensity in the vessel most pronounced at the level of C1
  • Abnormal flow-related signal in the right vertebral artery from the level of C1 through the distal V4 segment with areas of circumferential mural T2 signal hyperintensity more proximally in the vessel, most pronounced at the level of C3
  • T2/STIR signal hyperintensity in the right periauricular soft tissues
  • T2/STIR signal hyperintensity in the right mastoid temporal bone


Diagnosis

  • Traumatic arterial injury

Sample Report

Known fractures are not well demonstrated by MRI. No additional areas of marrow edema to suggest an additional fracture occult on CT.

Extensive prevertebral edema extending from the craniocervical junction to the level of C5 with evidence of interspinous ligament injury at C4-C5, C5-C6, and C6-C7. Mild edema in the supraodontoid space without disruption of the tectorial membrane or cruciate ligaments. Possible capsular injury involving the right atlantooccipital joint.

Abnormal flow-related signal in the right internal carotid artery from the level of C3 through the skull base and in the right vertebral artery from the level of C1 through the distal V4 segment concerning for traumatic dissection with slow flow versus occlusion. Circumferential mural T2 signal hyperintensity in both vessels raises concern for mural hematoma. Recommend CTA and/or catheter angiography for further assessment.


Discussion

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Images

Axial T2-weighted MR images at the level of C2 (left) and the skull base (center) and CTA axial image at the skull base (right) show abnormal flow-related signal loss and abnormal contrast filling in the right internal carotid (red arrows) and vertebral (yellow arrows) arteries compared to the normal left internal carotid (green arrows) and vertebral (blue arrows) arteries.



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