Question:

Regarding Vertebral Artery Loop Formation (VALF), which of the following statements is true?
1. VALF appears as signal void tubular structure on MRI.
2. VALF appears as extradural cystic mass extending into wide neural foramen on MRI.
3. VALF typically appears on MRI as tubular structure, isointense to muscles on T1 WI and slightly hyperintense to fat on T2 WI.
4. VALF is usually associated with abnormal pedicle signal intensity on MRI.
5. VALF is usually associated with posterior scalloping.





Answer:

The correct answer for the question "Regarding Vertebral Artery Loop Formation (VALF), which of the following statements is true?" is:

1. VALF appears as signal void tubular structure on MRI.



Explanation
1., 3. [ VALF or other vascular malformations are displayed as signal void tubular structures on MRI.]

2. [ MRI/MRA can confirm the diagnosis If they show signal void / vascular structure within the widened foramen.]

4. This is the typical appearance of metastatic destruction of a pedicle, not of VALF. [Metastatic destruction of a pedicle may widen the exit neural foramen, but must show abnormal pedicle lytic lesion on CT, abnormal pedicle signal intensity and possibly abnormal signal intensity extra-dural mass lesion on MRI images.]

5. This is the typical appearance of dural ectasia. [Congenital absence / hypoplasia of pedicle and  dural ectasia both have characteristic appearances on CT scans and do not show solid or cystic masses on MRI. Dural ectasia is usually associated with posterior vertebral scalloping.]



From the manuscript:
Symptomatic Vertebral Artery Loop: A case report and review of literature
Radiology Case. 2014 May; 8(5):35-41


This article belongs to the Interventional section.




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From the manuscript

Symptomatic Vertebral Artery Loop: A case report and review of literature

Free full text article: Symptomatic Vertebral Artery Loop:  A case report and review of literature

Abstract
Vertebral artery loop formation is a rare anatomical variant capable of causing bony erosion, encroachment on cervical neural foramen, neurovascular compression, or vertebrobasilar insufficiency. Health professionals should keep the diagnosis of vertebral artery loop formation in mind, especially when the plain radiograph of the cervical spine shows enlargement of the intervertebral foramen. If overlooked, serious complications like vertebral artery injury may occur during surgery or vertebrobasilar angiography, as well as cerebrovascular stroke during transforaminal cervical epidural steroid injections. This case report aims at increasing the awareness of both clinicians and radiologists of this entity as a known rare cause of cervical radiculopathy. In suspected cases, Magnetic resonance imaging & Magnetic resonance angiography should always be the first choice in this regard.






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