36 - CT Angiography of the Head and Neck

Summary

Noninvasive imaging techniques are playing an ever-increasing role in the diagnosis and management of patients with lesions of the vascular structures of the head and neck. In addition to identifying the site and severity of stenosis, occlusion, or trauma, imaging of the vasculature of the head and neck can provide vital information regarding tissue injury and perfusion (location, size, and degree of reversibility or hypoperfusion). The choice of the imaging test depends on patient characteristics, the disease condition, the availability of technique and equipment, and the preference of the interpreting physician. Increasingly, CT angiography (CTA) and magnetic resonance angiography (MRA) are replacing digital subtraction angiography (DSA) in the evaluation of cervicocranial vascular disorders. Evaluation of many vascular disorders is easily accomplished by either MRA or CTA, and the choice between the two may well rest on the availability of equipment or the preference of the interpreter. In many instances, DSA may be reserved for occasions when CTA/MRA findings are equivocal or not consistent with clinical symptoms. In the case of CTA, the rapid availability of information allows the astute physician to triage patients to appropriate therapies quickly, when the opportunity to treat patients with salvageable tissue who may benefit most from acute therapies is greatest.