MRA Head and Neck In the setting of acute trauma, MRA is considered a second-line noninvasive option behind CTA, which is faster, has fewer safety concerns, and is most useful in the initial imaging evaluation of suspected intracranial arterial injury [45]. MRA may be useful outside of the acute setting or when CTA is inconclusive (eg, for detection of T1 hyperintense subacute intramural hematoma in traumatic arterial dissection) [57]. Noncontrast MRA, using time- of-flight technique, can be used in patients who cannot receive iodinated or gadolinium-based contrast. MRI Functional (fMRI) Head There is no relevant literature to support the use of fMRI in the imaging evaluation of suspected intracranial arterial injury. MRI Head Please refer to MRA for neurovascular imaging evaluation of suspected intracranial arterial injury. Concurrent MRI may be useful in the clinical setting of suspected intracranial arterial injury for assessing structural changes to the brain since the most recent neuroimaging study (eg, new or progressive neurologic deficit). MRI Head with DTI There is no relevant literature to support the use of DTI in the imaging evaluation of suspected intracranial arterial injury. Radiography Skull There is no relevant literature to support the use of radiographs in the imaging evaluation of suspected intracranial arterial injury. Head Trauma Variant 9: Head trauma with suspected intracranial venous injury due to clinical risk factors or positive findings on prior imaging. Traumatic venous injury is an often-overlooked pathology that includes epithelial injury with thrombus formation and venous laceration with compressive hematoma [57]. The most common symptoms are highly variable and nonspecific (eg, headache and papilledema from intracranial hypertension or focal neurologic deficits from venous ischemia); they may be mistakenly attributed to other traumatic injuries [61].
Head Trauma PCAs. MRA Head and Neck In the setting of acute trauma, MRA is considered a second-line noninvasive option behind CTA, which is faster, has fewer safety concerns, and is most useful in the initial imaging evaluation of suspected intracranial arterial injury [45]. MRA may be useful outside of the acute setting or when CTA is inconclusive (eg, for detection of T1 hyperintense subacute intramural hematoma in traumatic arterial dissection) [57]. Noncontrast MRA, using time- of-flight technique, can be used in patients who cannot receive iodinated or gadolinium-based contrast. MRI Functional (fMRI) Head There is no relevant literature to support the use of fMRI in the imaging evaluation of suspected intracranial arterial injury. MRI Head Please refer to MRA for neurovascular imaging evaluation of suspected intracranial arterial injury. Concurrent MRI may be useful in the clinical setting of suspected intracranial arterial injury for assessing structural changes to the brain since the most recent neuroimaging study (eg, new or progressive neurologic deficit). MRI Head with DTI There is no relevant literature to support the use of DTI in the imaging evaluation of suspected intracranial arterial injury. Radiography Skull There is no relevant literature to support the use of radiographs in the imaging evaluation of suspected intracranial arterial injury. Head Trauma Variant 9: Head trauma with suspected intracranial venous injury due to clinical risk factors or positive findings on prior imaging. Traumatic venous injury is an often-overlooked pathology that includes epithelial injury with thrombus formation and venous laceration with compressive hematoma [57]. The most common symptoms are highly variable and nonspecific (eg, headache and papilledema from intracranial hypertension or focal neurologic deficits from venous ischemia); they may be mistakenly attributed to other traumatic injuries [61].