Arteriography Cervicocerebral Catheter-directed cerebral angiography has the highest spatial resolution and temporal resolution of any vascular study. As such, catheter-directed angiography is the most accurate means of grading a cervical dissection, delineating the degree of associated stenosis, and may also be useful in assessment of collateral circulation. Additionally, some subtle dissections may be more apparent due to higher spatial resolution. However, the usefulness of this technique in screening for dissection is obviated by the invasive nature of the test. There is no literature supporting cerebral angiography as the initial imaging test for suspected cervical vascular dissection. Cervicocerebral angiography may influence treatment options after the initial diagnosis of dissection in patients with severe presenting symptoms such as focal neurological deficits [126]; however, the degree of stenosis may not influence the rate of further stroke [127,128]. Cerebrovascular Diseases-Stroke CT Head Perfusion With IV Contrast There is no literature to support the use of CTP in the initial imaging of suspected cervical vascular dissection or injury. CT Head With IV Contrast There is no relevant literature to support the use of contrast-enhanced CT of the head in the initial imaging of suspected cervical vascular dissection or injury. 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 initial imaging of suspected cervical vascular dissection or injury. CT Head Without IV Contrast Noncontrast CT may be useful in the setting of a known dissection to evaluate for complications such as hemorrhagic conversion, mass effect, and herniation or in the exclusion of ICH before the initiation of anticoagulation or antiplatelet therapy for a known dissection. However, MRI is much more sensitive in evaluating recent strokes.
Cerebrovascular Diseases Stroke and Stroke Related Conditions PCAs. Arteriography Cervicocerebral Catheter-directed cerebral angiography has the highest spatial resolution and temporal resolution of any vascular study. As such, catheter-directed angiography is the most accurate means of grading a cervical dissection, delineating the degree of associated stenosis, and may also be useful in assessment of collateral circulation. Additionally, some subtle dissections may be more apparent due to higher spatial resolution. However, the usefulness of this technique in screening for dissection is obviated by the invasive nature of the test. There is no literature supporting cerebral angiography as the initial imaging test for suspected cervical vascular dissection. Cervicocerebral angiography may influence treatment options after the initial diagnosis of dissection in patients with severe presenting symptoms such as focal neurological deficits [126]; however, the degree of stenosis may not influence the rate of further stroke [127,128]. Cerebrovascular Diseases-Stroke CT Head Perfusion With IV Contrast There is no literature to support the use of CTP in the initial imaging of suspected cervical vascular dissection or injury. CT Head With IV Contrast There is no relevant literature to support the use of contrast-enhanced CT of the head in the initial imaging of suspected cervical vascular dissection or injury. 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 initial imaging of suspected cervical vascular dissection or injury. CT Head Without IV Contrast Noncontrast CT may be useful in the setting of a known dissection to evaluate for complications such as hemorrhagic conversion, mass effect, and herniation or in the exclusion of ICH before the initiation of anticoagulation or antiplatelet therapy for a known dissection. However, MRI is much more sensitive in evaluating recent strokes.