Case Images
Case Notes
History
42 year old male with right sided numbness and neck pain; history of seizures and hypertension.Exam
MRA of the Neck
Our 3D MRA of the neck is performed in coronal plane post –contrast (IV Gadolinium). Rapidly obtained images are post processed to obtained MRA visualization of the intracranial cerebral arteries. The data set is obtained quickly and only once. Thus, there is no unsubtracted axial imaging to evaluate the arterial wall as in CTA. However, axial MRA imaging of the neck can be performed in addition to the 3DMRA of the neck in order to image the soft tissue neck structures including the arteries and veins. These images are very helpful in recognizing acute thrombus in the arterial wall (dissection). Axial soft tissue MR imaging is especially helpful in detecting thrombus in the vertebral arteries (which are surrounded by vein which obscures detail on CTA) and in thrombus within the carotid canal (where detail is lost by bone density on CTA). MRA of the neck can also be performed without contrast using time of flight technique, but this lacks the clarity of the post contrast 3D MRA.
Purpose
1. Define sites of any and all arterial thromboses or flow-limiting, high-grade stenosis, or tandem stenoses with lesser degrees of luminal narrowing, but are included within the same arterial circuit;
2. Characterize the features of the stenotic/occluded arterial segment (NASCET, assess length of stenosis/occlusion, intimal dehiscence, atherosclerotic vs inflammatory basis, etc.);
3. Determine whether there is effective collateral around any occluded segment;
4. Assess the presence of effective EC-IC collateral in cases of extradural ICA occlusion
Our 3D MRA of the neck is performed in coronal plane post –contrast (IV Gadolinium). Rapidly obtained images are post processed to obtained MRA visualization of the intracranial cerebral arteries. The data set is obtained quickly and only once. Thus, there is no unsubtracted axial imaging to evaluate the arterial wall as in CTA. However, axial MRA imaging of the neck can be performed in addition to the 3DMRA of the neck in order to image the soft tissue neck structures including the arteries and veins. These images are very helpful in recognizing acute thrombus in the arterial wall (dissection). Axial soft tissue MR imaging is especially helpful in detecting thrombus in the vertebral arteries (which are surrounded by vein which obscures detail on CTA) and in thrombus within the carotid canal (where detail is lost by bone density on CTA). MRA of the neck can also be performed without contrast using time of flight technique, but this lacks the clarity of the post contrast 3D MRA.
Purpose
1. Define sites of any and all arterial thromboses or flow-limiting, high-grade stenosis, or tandem stenoses with lesser degrees of luminal narrowing, but are included within the same arterial circuit;
2. Characterize the features of the stenotic/occluded arterial segment (NASCET, assess length of stenosis/occlusion, intimal dehiscence, atherosclerotic vs inflammatory basis, etc.);
3. Determine whether there is effective collateral around any occluded segment;
4. Assess the presence of effective EC-IC collateral in cases of extradural ICA occlusion
Prior Study
Non-Contrast Head CT1. Acute thrombus in the high cervical and vertical intrapetrous segments of the left cervical ICA without evidence of acute cerebral stroke. The history of acute upper neck pain makes dissection a likely possibility.
2. Head is negative for hyperacute stroke changes
