However, the requirement for iodinated contrast detracts from this examination in comparison to Doppler and MRA. CTV Head With IV Contrast There is no relevant literature to support the use of CTV of the head in the evaluation of the asymptomatic patient with a carotid bruit. MRA Head Without and With IV Contrast There is no relevant literature to support the use of contrast-enhanced MRA of the head in the evaluation of the asymptomatic patient with a carotid bruit. MRA Head Without IV Contrast There is no literature to support MRA of the head in the initial workup of the asymptomatic patient with a carotid bruit. MRA of the head may be useful in treatment planning for patients with an established diagnosis of carotid stenosis. Intracranial collateral characterization may be important when considering proximal embolic protection strategies. MRA Neck Without and With IV Contrast MRA of the neck is useful in the initial workup of the asymptomatic patient with a carotid bruit owing to the anatomic assessment of stenosis, which will limit both false-positives and false-negatives. Specifically, MRA of the neck is helpful when multivessel cerebrovascular disease or very severe stenosis is present, which might result in artifactual over- or underestimation of the degree of disease by carotid Doppler, respectively [113]. Noncontrast MRA of the neck may overestimate the degree of stenosis when severe and/or near occlusive. Contrast administration can reduce the degree of overestimation of the degree of stenosis in some cases. However, contrast- enhanced MRA of the neck has a similar sensitivity for the detection of >70% stenosis of the carotid when 2-D and 3-D techniques of TOF are combined [27,117]. MRA of the neck may also be useful for treatment planning. However, the anatomic definition of the surrounding structures may be inadequate for treatment planning in some cases depending on the sequences used [114].
Cerebrovascular Diseases Stroke and Stroke Related Conditions PCAs. However, the requirement for iodinated contrast detracts from this examination in comparison to Doppler and MRA. CTV Head With IV Contrast There is no relevant literature to support the use of CTV of the head in the evaluation of the asymptomatic patient with a carotid bruit. MRA Head Without and With IV Contrast There is no relevant literature to support the use of contrast-enhanced MRA of the head in the evaluation of the asymptomatic patient with a carotid bruit. MRA Head Without IV Contrast There is no literature to support MRA of the head in the initial workup of the asymptomatic patient with a carotid bruit. MRA of the head may be useful in treatment planning for patients with an established diagnosis of carotid stenosis. Intracranial collateral characterization may be important when considering proximal embolic protection strategies. MRA Neck Without and With IV Contrast MRA of the neck is useful in the initial workup of the asymptomatic patient with a carotid bruit owing to the anatomic assessment of stenosis, which will limit both false-positives and false-negatives. Specifically, MRA of the neck is helpful when multivessel cerebrovascular disease or very severe stenosis is present, which might result in artifactual over- or underestimation of the degree of disease by carotid Doppler, respectively [113]. Noncontrast MRA of the neck may overestimate the degree of stenosis when severe and/or near occlusive. Contrast administration can reduce the degree of overestimation of the degree of stenosis in some cases. However, contrast- enhanced MRA of the neck has a similar sensitivity for the detection of >70% stenosis of the carotid when 2-D and 3-D techniques of TOF are combined [27,117]. MRA of the neck may also be useful for treatment planning. However, the anatomic definition of the surrounding structures may be inadequate for treatment planning in some cases depending on the sequences used [114].