Imaging

Carotid Dissection

Preliminary Diagnosis: Carotid Dissection

I. What imaging technique is first-line for this diagnosis?

  • CTA of the head and neck with IV contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of carotid dissection.

Advantages

  • Highly sensitive and specific in diagnosing and detailing the extent of the carotid dissection

  • Able to exquisitely visualize the true and false lumen and evaluate for any underlying process or secondary complication, i.e., pseudoaneursym or active extravasation

Disadvantages

  • Exposes patients to large amounts of ionizing radiation

  • May be subject to metallic streak artifact and beam-hardening artifact, limiting evaluation of the adjacent vascular structures

  • IV contrast is contraindicated in patients with elevated creatinine, i.e., >1.6, and/or those not on dialysis with abnormal renal function

III. What are the contraindications for the first-line imaging technique?

  • May be contraindicated in pregnant patients

  • IV contrast required for CTA is contraindicated in patients with elevated creatinine levels (institution specific) and not on active dialysis

IV. What alternative imaging techniques are available?

MRA of the head and neck with and/or without contrast. Axial fat saturated noncontrast T1 images of the neck should be performed per dissection protocol.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of carotid dissection.

MRA of the head and neck with and/or without contrast

Advantages

  • Does not expose the patient to ionizing radiation

  • Does not have to performed with contrast and can be performed with time of flight protocol

Disadvantages

  • Less specific and sensitive in diagnosing and detailing the extent of a carotid dissection compared with CT imaging.

  • May be subject to motion artifact due to length of the exam and susceptibility weighted artifact

VI. What are the contraindications for the alternative imaging techniques?

MRA of the head and neck with and/or without contrast

Contraindicated in patients with non-MR-compatible hardware

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