CT Head Without and With IV Contrast There is no relevant literature to support the use of contrast-enhanced CT of the head in the evaluation of the asymptomatic patient with a carotid bruit. CT Head Without IV Contrast There is no literature to support noncontrast CT of the head in the initial workup of the asymptomatic patient with a carotid bruit. Noncontrast CT of the head is useful in evaluating for the sequela of known asymptomatic carotid stenosis such as clinically silent strokes or microvascular ischemic changes. However, MRI is much more sensitive in evaluating microvascular ischemic changes or recent strokes. Symptomatic carotid disease should be evaluated relative to the underlying symptoms. Please see Variants 1 to 5 for a discussion of appropriate imaging. CTA Head With IV Contrast CTA of the head may be useful in treatment planning for patients with an established diagnosis of asymptomatic carotid stenosis. However, there is no literature to support CTA of the head in the initial workup for the asymptomatic patient with a carotid bruit. CTA Neck With IV Contrast CTA of the neck is useful in the initial workup of the asymptomatic patient with a carotid bruit owing to the anatomic assessment of stenosis as well as status of the other cervical vessels. Specifically, CTA 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]. CTA of the neck is also useful for treatment planning [114]. However, CTA of the neck may also underestimate the degree of stenosis in the setting of tortuosity or calcifications similar in density to contrast media [24]. Conversely, CTA may overestimate stenosis in the setting of very severe near occlusive stenosis [115]. Dual-energy CT may help limit overestimation of stenosis in some instances [116].
Cerebrovascular Diseases Stroke and Stroke Related Conditions PCAs. CT Head Without and With IV Contrast There is no relevant literature to support the use of contrast-enhanced CT of the head in the evaluation of the asymptomatic patient with a carotid bruit. CT Head Without IV Contrast There is no literature to support noncontrast CT of the head in the initial workup of the asymptomatic patient with a carotid bruit. Noncontrast CT of the head is useful in evaluating for the sequela of known asymptomatic carotid stenosis such as clinically silent strokes or microvascular ischemic changes. However, MRI is much more sensitive in evaluating microvascular ischemic changes or recent strokes. Symptomatic carotid disease should be evaluated relative to the underlying symptoms. Please see Variants 1 to 5 for a discussion of appropriate imaging. CTA Head With IV Contrast CTA of the head may be useful in treatment planning for patients with an established diagnosis of asymptomatic carotid stenosis. However, there is no literature to support CTA of the head in the initial workup for the asymptomatic patient with a carotid bruit. CTA Neck With IV Contrast CTA of the neck is useful in the initial workup of the asymptomatic patient with a carotid bruit owing to the anatomic assessment of stenosis as well as status of the other cervical vessels. Specifically, CTA 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]. CTA of the neck is also useful for treatment planning [114]. However, CTA of the neck may also underestimate the degree of stenosis in the setting of tortuosity or calcifications similar in density to contrast media [24]. Conversely, CTA may overestimate stenosis in the setting of very severe near occlusive stenosis [115]. Dual-energy CT may help limit overestimation of stenosis in some instances [116].