Screening for Mild Vertebral Artery Dissection Using 3-Dimensional T1-weighted Black-blood Magnetic Resonance Imaging: A Retrospective Observational Study of 3,049 Consecutive Walk-in Patients Presenting with Headache.

Vertebral artery dissection is a rare but potentially life-threatening condition. However, many cases of mild vertebral artery dissection-an early disease stage-may be overlooked. 3-dimensional T1-weighted black-blood magnetic resonance imaging has recently emerged as a promising diagnostic tool, yet it remains underutilized. This study investigated the impact of vertebral artery dissection screening in patients presenting with headache, the most common chief complaint encountered in general neurosurgery outpatient clinics, and an initial symptom of vertebral artery dissection, in a real-world clinical setting. We retrospectively reviewed 3,049 consecutive patients with headache who visited a neurosurgical outpatient center in Chiba, Japan (October 2021-October 2023). In the first year, 1,527 patients underwent brain magnetic resonance imaging and magnetic resonance angiography. In the second year, 1,522 patients received these examinations as well as brain and neck black-blood magnetic resonance imaging. Vertebral artery dissection detection rates were compared between the 2 groups.Vertebral artery dissection was diagnosed in 0.5% and 1.6% of the former and latter groups, respectively (relative risk: 3.42, 95% confidence interval 1.48-7.92, p = 0.003), indicating an over threefold increase in detection. Among patients with intracranial vertebral artery dissection, 96% reported occipital headache rather than nonspecific/generalized headache. Among high-risk individuals aged 40-55 years with occipital or posterior neck pain, the detection rate reached 7.5%. Vertebral artery dissection accounted for 93% of head and neck arterial dissections. The addition of black-blood magnetic resonance imaging significantly improved early detection and may enhance screening accuracy for patients presenting with headache at elevated risk.