There is no current literature comparing the efficacy of contrast-enhanced CT to CTA or MRI and MRA for the evaluation of a pulsatile neck mass. Advances in lower dose protocols and reconstruction vary among vendors [32], and all imaging should reflect ALARA practices [33]. CTA Neck Although CTA is optimized to visualize the cervical arteries, the soft tissues are usually well characterized. There is no current literature comparing efficacy of contrast-enhanced CT to CTA or MRI and MRA for the evaluation of a pulsatile neck mass. MRI Neck The primary advantage of MRI is improved soft-tissue intrinsic contrast. A noncontrast MRI also serves a role for anatomic definition of a pulsatile neck mass in patients who cannot receive contrast. There is no current literature comparing efficacy of contrast-enhanced CT to CTA or MRI and MRA for the evaluation of a pulsatile neck mass. Arterial phase, time-resolved (4-D) MRI may be useful for evaluation of possible paragangliomas in the head and neck [59-61], but it is not an initial imaging study of a new palpable neck mass. MRA Neck MRA is complementary to MRI in the evaluation of a pulsatile neck mass to achieve anatomic and vascular detail. Time resolved (4-D) contrast-enhanced MRA technique may be useful for characterization of head and neck arteriovenous malformations [62]. There is no current literature comparing efficacy of contrast-enhanced CT to CTA or MRI and MRA for the evaluation of a pulsatile neck mass. The use of contrast for MRA is institution dependent but generally preferred. US Neck US may identify a distinct mass overlying or adjacent to an artery, may confirm vascularity of a lesion, or may be useful to confirm a clinical suspicion of a tortuous artery. The characteristic US appearance of phleboliths may aid in the diagnosis of low-flow vascular malformations [59].
Neck Mass Adenopathy. There is no current literature comparing the efficacy of contrast-enhanced CT to CTA or MRI and MRA for the evaluation of a pulsatile neck mass. Advances in lower dose protocols and reconstruction vary among vendors [32], and all imaging should reflect ALARA practices [33]. CTA Neck Although CTA is optimized to visualize the cervical arteries, the soft tissues are usually well characterized. There is no current literature comparing efficacy of contrast-enhanced CT to CTA or MRI and MRA for the evaluation of a pulsatile neck mass. MRI Neck The primary advantage of MRI is improved soft-tissue intrinsic contrast. A noncontrast MRI also serves a role for anatomic definition of a pulsatile neck mass in patients who cannot receive contrast. There is no current literature comparing efficacy of contrast-enhanced CT to CTA or MRI and MRA for the evaluation of a pulsatile neck mass. Arterial phase, time-resolved (4-D) MRI may be useful for evaluation of possible paragangliomas in the head and neck [59-61], but it is not an initial imaging study of a new palpable neck mass. MRA Neck MRA is complementary to MRI in the evaluation of a pulsatile neck mass to achieve anatomic and vascular detail. Time resolved (4-D) contrast-enhanced MRA technique may be useful for characterization of head and neck arteriovenous malformations [62]. There is no current literature comparing efficacy of contrast-enhanced CT to CTA or MRI and MRA for the evaluation of a pulsatile neck mass. The use of contrast for MRA is institution dependent but generally preferred. US Neck US may identify a distinct mass overlying or adjacent to an artery, may confirm vascularity of a lesion, or may be useful to confirm a clinical suspicion of a tortuous artery. The characteristic US appearance of phleboliths may aid in the diagnosis of low-flow vascular malformations [59].