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Vertebrobasilar Dolichoectasia


KEY FACTS

Terminology

  • Extensive ectatic, elongated vertebrobasilar artery (VBA)

  • Usually associated with decreased blood flow velocity

Imaging

  • General findings

    • Irregular, elongated, tortuous VBA

    • Usually 6-12 mm, can be giant (> 2.5 cm)

    • Focal arterial dilatation = fusiform aneurysm

  • CT

    • Hyperdense tortuous enlarged vessel, Ca++ common

    • Enlarged lumen enhances, intramural thrombus does not

  • MR

    • Signal varies with flow, presence/age of thrombus

    • Dynamic CE MRA best

    • 3D TOF inadequate (slow flow saturation effects)

Top Differential Diagnoses

  • Fusiform aneurysm, ASVD

  • Giant serpentine aneurysm

  • Nonatherosclerotic fusiform vasculopathy

  • Dissecting aneurysm

Clinical Issues

  • Peak age = 7th, 8th decades

  • Often asymptomatic

    • Vertebrobasilar TIAs

    • Progressive cranial nerve compression less common

      • –

        CN5, 7; hemifacial spasm

    • Rare: Hemorrhage, hydrocephalus

Diagnostic Checklist

  • Slow complex flow → heterogeneous signal, TOF artifact

  • Dynamic contrast-enhanced CTA/MRA or DSA necessary to delineate true lumen

Autopsied brain seen from below shows ectatic, very tortuous basilar artery
with extensive yellow plaques of atherosclerosis. No focal areas of dilatation are seen, so this is vertebrobasilar dolichoectasia, a relatively common finding in elderly patients.

(Courtesy R. Hewlett, MD.)

Sagittal T1WI MR in a 76-year-old man with headaches shows a very elongated, unusually ectatic basilar artery
. The basilar tip elevates and indents the 3rd ventricle
.

Axial T1 C+ FS MR shows the strongly enhancing basilar bifurcation
as it indents the inferior 3rd ventricle.

Coronal T1 C+ MR shows the extremely ectatic, elongated basilar artery
characteristic of typical vertebrobasilar dolichoectasia.

TERMINOLOGY

Abbreviations

  • Vertebrobasilar dolichoectasia (VBD)

Synonyms

  • Fusiform vertebrobasilar ectasia

Definitions

  • Extensive ectatic, elongated vertebrobasilar artery (VBA)

    • Usually associated with decreased blood flow velocity

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