CTA Neck With IV Contrast CTA of the neck is useful in ongoing surveillance imaging of cervical vascular dissection owing to high spatial resolution of the examination. The high resolution of CTA allows for the detection of subtle dissections with high sensitivity for both cervical carotid and vertebral artery dissections with a sensitivity and specificity approaching 98%, which informs the usefulness of CTA in follow-up surveillance imaging [129]. CTA can rapidly and accurately grade the degree of luminal narrowing, vessel irregularity, wall thickening/hematoma, pseudoaneurysm, and intimal flap, which may make it preferable to MRA [130]. CTA also allows for accurate grading of dissections comparable to digital subtraction angiography, which may be helpful in clinical management [131]. The potential detractors from CTA of the neck are the requirements for iodinated contrast and ionizing radiation. CTV Head With IV Contrast There is no relevant literature to support the use of CTV of the head in the surveillance imaging of cervical vascular dissection. 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 surveillance imaging of cervical vascular dissection. Cerebrovascular Diseases-Stroke MRA Head Without IV Contrast There is no literature to support MRA of the head in the routine surveillance of known dissections isolated to the cervical vasculature. MRA of the head may be useful in the surveillance of cervical vascular dissections that are known to extend into the intracranial vasculature. MRA of the head may also be useful for the evaluation of intracranial collaterals of the circle of Willis and excluding associated intracranial LVO in patients with ongoing symptoms, which is important in stroke risk stratification and treatment strategies.
Cerebrovascular Diseases Stroke and Stroke Related Conditions PCAs. CTA Neck With IV Contrast CTA of the neck is useful in ongoing surveillance imaging of cervical vascular dissection owing to high spatial resolution of the examination. The high resolution of CTA allows for the detection of subtle dissections with high sensitivity for both cervical carotid and vertebral artery dissections with a sensitivity and specificity approaching 98%, which informs the usefulness of CTA in follow-up surveillance imaging [129]. CTA can rapidly and accurately grade the degree of luminal narrowing, vessel irregularity, wall thickening/hematoma, pseudoaneurysm, and intimal flap, which may make it preferable to MRA [130]. CTA also allows for accurate grading of dissections comparable to digital subtraction angiography, which may be helpful in clinical management [131]. The potential detractors from CTA of the neck are the requirements for iodinated contrast and ionizing radiation. CTV Head With IV Contrast There is no relevant literature to support the use of CTV of the head in the surveillance imaging of cervical vascular dissection. 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 surveillance imaging of cervical vascular dissection. Cerebrovascular Diseases-Stroke MRA Head Without IV Contrast There is no literature to support MRA of the head in the routine surveillance of known dissections isolated to the cervical vasculature. MRA of the head may be useful in the surveillance of cervical vascular dissections that are known to extend into the intracranial vasculature. MRA of the head may also be useful for the evaluation of intracranial collaterals of the circle of Willis and excluding associated intracranial LVO in patients with ongoing symptoms, which is important in stroke risk stratification and treatment strategies.