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  • Any good reference articles on the basics of CTA head and Neck?

    Posted by Unknown Member on April 21, 2023 at 8:45 am

    Have to start covering a hospital ER where they do these and I don’t have much experience. Usually will have Neurorad backup, but just in case!
     

    RT340067 replied 1 year, 2 months ago 12 Members · 14 Replies
  • 14 Replies
  • tselvidas_246

    Member
    April 21, 2023 at 9:14 am

    bump

    • econway

      Member
      April 21, 2023 at 9:35 am

      This might help:  [link]https://www.ctisus.com/[/link]

      • pankajkaira1982_700

        Member
        April 21, 2023 at 10:27 am

        Neurorad here. Read up on craniocervical dissection in Radiographics .

        • Gaynorjarvis

          Member
          April 21, 2023 at 12:11 pm

           
          [link]https://www.edneurorad.com/category/vascular/[/link]

          • Unknown Member

            Deleted User
            April 23, 2023 at 3:40 pm

            These have been helpful but I am looking for a “radiographics” style article with examples of common pathologies etc…

            • Melenas

              Member
              April 23, 2023 at 4:52 pm

              sounds like a good RD article to write. 

              • Melenas

                Member
                April 23, 2023 at 4:58 pm

                [link=https://www.ajronline.org/doi/pdfplus/10.2214/ajr.185.3.01850772?src=recsys]https://www.ajronline.org/doi/pdfplus/10.2214/ajr.185.3.01850772?src=recsys[/link]

            • Gaynorjarvis

              Member
              April 23, 2023 at 5:10 pm

              I mean there’s a lot of pathology ranging from vascular to nonvascular portions so you might have to find a lot of those articles. 

              You have anatomical variants, NASCET critieria. neck pathology, acute vascular complications among others for each report. 
               
              Are you also going to be reading RAPID’s/cerebral perfusion maps?
               
               

              • namaalamry_845

                Member
                April 23, 2023 at 5:19 pm

                Casestacks website is good.

                • talia784

                  Member
                  April 24, 2023 at 12:10 am

                  Don’t have an article but a few tips based on common misses:
                   
                  -Biggest “ouch” misses are always the non-vascular things — skull base masses, spine masses/osteo, and lung stuff
                  -PCA pathology is probably most commonly missed since every CTA has some degree of opacification of the basal vein of Rosenthal which runs alongside it. The MIPs sometimes don’t help. I always recommend checking the PCA on coronal and/or sagittal. This will really build your confidence if you’re ever calling tight stenosis/occlusion here
                  -ICAs at the skull base and cavernous segments. People blow by stenoses and aneurysms here every now and then
                   
                  Other than those three things, if you can read a CTA anywhere else I think you’ll do just fine. Your Neuro colleagues can help you troubleshoot unusual things and overcalling/undercalling a stenosis here and there isn’t a big deal.
                   
                  Oh — bonus tip to check MCAs on sagittal. I find this is really the best way to catch M2 occlusions. 

                  • ranweiss

                    Member
                    April 24, 2023 at 6:19 am

                    Agree with articles listed above. 
                     
                    As a neurorad, i’ll say CTA misses I usually run across are typically anatomic things, less likely a decent rad will miss an occlusion, dissection, etc….Just make sure to always double check the neck structures, thyroid, skull base, etc – I  see a lot of misses in those spots. 

                    • buckeyeguy

                      Member
                      April 24, 2023 at 7:14 am

                      Good rec by apoplexy on the M2 verification on the sagittal. I’m curious as to how much something like “stenosis” is actually acted on. Of course, the aneurysms and occlusions I see the “value” in, but the other stuff just seems academic, and to be quite honest, something the system built in to portray meaning but ultimately there isn’t much one can do about it… but hey, mission accomplished, they order CTAs on everyone, yay!

                    • andy.lippman_422

                      Member
                      April 25, 2023 at 1:28 am

                      Usually people who have intracranial atherosclerosis tend to not have much cervical one. So yeah unlike CEA which works very well, there’s not much you can do for intracranial stenoses. I still report them if they’re noticeable bc it feels weird not to, but I don’t think there’s too much you can do there.

                    • RT340067

                      Member
                      April 25, 2023 at 10:41 am

                      As above, always confirm the vessels patency on sagittal and coronal reformats. I saw a case this weekend where an outside rad missed a proximal M2 occlusion. Thankfully, the telestroke neurologist caught it after their exam and the CTA read didn’t match up. There was a vein right next to the M2 that I am sure the outside rad thought was the patent vessel.