How to read a CT angiogram (CTA) of the Head and Neck
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- เผยแพร่เมื่อ 28 มิ.ย. 2024
- With increasing ability to image vascular phenomena, such as stroke and vascular malformations, through the use of very efficient and high speed computed tomography scanner (CT), we now have the ability to perform angiographic imaging of large segments of the body at one time. This has led to an explosion of vascular imaging of the head and neck to look for a variety of pathologies, including stroke, vascular malformations, and other vascular abnormalities. Every starting radiology resident needs a firm foundation in how to interpret these images.
0:43 Overview
Because there are a ton of images and a ton of structures that you need to look at, you really need a regimented approach, or search pattern, to use as you look through the images. In this video, I teach you how to look at a CT angiogram of the head and neck from start to finish so you can learn how to do it yourself. There are interactive examples that you can follow along at our webpage:
learnneuroradiology.com/vascu...
In this video, we go through a normal example which you can find here
bit.ly/CTAnormal
I divide the study into the CTA of the neck, which I review first, and the CTA of the head, which I review second. My pattern goes as follows:
3:42 Nonvascular structures
I first like to look at all the nonvascular structures to make sure I’m not missing anything. I look at the lungs, the thyroid, the soft tissues of the neck (particularly to look for lymph nodes or mucosal masses), and the brain. I use a soft tissue window to look at these. Then I go back through with a bone window to look at the bones.
5:42 Neck Vessels
For the vessels of the neck, I use an approach that first does anterior vessels and then posterior vessels, moving from right to left. I follow the right common carotid artery through the bifurcation, and then follow the internal carotid to the skull base. I then repeat this pattern for the left carotid system. Then, I start from the right vertebral origin and follow it up to the skull base. Then the left vertebral artery. Once I’m finished, I restart at the skull base.
11:19 Head Vessels
For the vessels of the head, I follow a similar approach. I first follow the right ICA through the carotid terminus and then follow the right middle cerebral artery (MCA) and anterior cerebral artery(ACA). Once finished, I return to the skull base and repeat this pattern on the left. I then move to the posterior circulation, where I first follow the right vertebral artery, the basilar artery, and the right posterior cerebral artery (PCA). Then I repeat it on the left. My final search is to quickly look at the deep venous sinuses.
16:57 Summary
While others may have a different strategy, the most important part is to have a strategy and stick to it. This pattern of dividing the study into discrete sections will help you see all the findings and describe them accurately when reading cases on your own.
Check out this video and additional content on www.learnneuroradiology.com
Neurology resident here struggling with neuroradiology! 😭 you have no idea how you’re helping me….thank you so very much.
You are so welcome! Thanks for checking it out!
Dr. Weinberg, thank you for taking the time to create all of this excellent free content. Your content is an invaluable resource for all radiology residents.
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People like you are the asset of our planet, teaching selflessly
The world is a better place with teachers like you
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Incredibly helpful! Thank you so much.
I'm emergency doc in korea. this recture is great. thank you so much. you are the savior.
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One of the clearest explanations! Thank you very much for making this video! Thank you.
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Excellent. Thank you sharing through TH-cam.
Great lectures. Excellent teacher
Excellent break down and explanation. Thank you!
Glad it was helpful!
R1 here - you are a gifted teacher, thank you for these excellent videos.
Wow, thank you! I'm glad you like them and hopefully it makes your residency a little easier!
Thanks a lot . excellent as usual .
Thank you for your lectures👍👍👍
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Excellently presented. Thank you
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First year Rad resident here. Thanks a lot! Very helpful
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excellent teaching, thank you so much!
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The best explanation ever! I am very grateful!
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The best video ever, thank you so much!!! ❤️
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Very helpful! Thank you!
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Great work thanks.
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Excellent explanation
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Excellent explained in a simple way...
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Great lectures.
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I am neurology research fellow at Grady and that helps me a lot
Great to hear! Stop by neuroradiology if you have any questions!
@@LearnNeuroradiology Thank you and if you organize any live lectures I will be happy to attend
Sounds good! Will do!
Extremely useful, thanks very much... do you have other videos about the how to look and read the perfusion and DTI scans? If not, could you please recommend something for me?
We do have some videos about doing DTI, both interpretation and processing:
th-cam.com/video/gpaleRyQPJc/w-d-xo.html
Not much about perfusion yet but hopefully we can get one soon. You might check out this paper:
www.ahajournals.org/doi/10.1161/STROKEAHA.119.028337
Thank you sir for such a nice video
Most welcome
This was extremely useful! Do you have a video interpreting the vascular anatomy of the neck from an oblique view?
Not yet! That's an interesting idea. In radiology we really don't primarily interpret with the oblique views, but we do use them to troubleshoot and measure degree of stenosis. It would be an interesting short video to make. Thanks for stopping in!
@@LearnNeuroradiology as a term 2 student, a lateral view is usually tested, but I think it was an angiogram or CT or something of lateral view of the head and neck. basically the carotids, laryngeal, etc. and how they enter cranial vault etc. apologies for the misuse of terminology, I'm only term 2 :D
Ah, it seems like you mean that you saw either a view from a lateral angiogram or a sagittal reformat of CTA. Historically, that's important because catheter angiograms were done that way. Tests have a way of emphasizing a way of looking at things that is not common in practice anymore.
I'll see if I can come up with something to show it from different views in a later video.
Great lecture Sir👍
Thanks and welcome
Thank you!!! Could you please do a video on reading a CT venogram
Great idea! I'll try to cover it in a lecture sometime soon!
Thank u sir
Welcome!
Hi there , this is a great video it’s helped me a lot in understanding my insides . Please can you tell me if this type of scan shows veins . In particular does it show the internal jugular veins , I recently had a Ct angiogram of head and neck with contrast but in the report the doctor only mentions arteries and not the veins , but I think I have stenosis of the right internal jugular vein at the C1 vertebrae level . I would really appreciate it if you can help me . Thanks
See the other reply I sent you, but it's very unusual to have jugular stenosis.
Sorry, I see why that's confusing. Look at the comments on this video
th-cam.com/video/FwHKACkqcXY/w-d-xo.html
Do you routinely use saggital images or do you just use them for problem saving. In addition, do you routinely use MIP reformats? Just asking because the Neuro attendings at my institutions teach us to always use MIPS and to use saggitals to look at basilar tip and carotid bifurcation (just curious; i realize there are many differences in practice)
Yes, once I finish my regular search, I usually look at axial, coronal, and sagittal MIPS through the brain. Quickly, but it is a nice check to see if you catch any other abnormalities.
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When doing a neck cta does it show the internal carotid artery up in the skull or would you need a head cta to view that part of the artery?
Yes, it goes pretty far into the skull but how far actually might depend on the technologist preference and the institution. Technically though it should go all the way to the end of the internal carotid (when it splits into MCA and ACA).
it would have been cool to explain more about the different segments of the arteries.. i think they are not as easy to distinguish in ct scans 🤔
I think it's a reasonable suggestion, but the segments are not really as important in real life as they are in textbooks
I'm scheduled for a CT angio of head and neck. I'm curious if the scan will pick up the area right below my collarbone. I keep saying the issue feels like it is(it is) coming from back of my upper spine right below base of neckline. Like in my T1 T2 area, and is causing the dull aching, with sometimes sharp pain in certain movements, but mainly just a tingly palsy type sensation into right side of face. Like I've slept on side of face and it's almost awake but not all the way. Or like in my right side corner of Lips and partial bottom right lip, and up into around my right eye socket and temple area, it's sort of like when you go to the dentist and have been numbed up and it's just about wore off but the puffiness is still kinda there.
That's the hell I live.
All I get is that it's muscle related and to try muscle relaxers, or physical therapy exercises to strengthen my neck. None of it works.
So now they are looking for blood flow. But it seems like this is only gonna look at my upper neck and brain, not actually in my upper back and up into right side of my face.
Can this scan see the smaller veins supplying blood to my right jawline and cheek area, plus around the corner of eye and temple area?
CTAs usually start at the top of the aortic arch (near T1-T2) and go all the way up to the top of the head. So usually you see the clavicular head and T1-T2 area, but it is rare to have any abnormality that you can see in that area.
You can see arteries and veins that supply the face, but it's not very common for them to have significant abnormalities. From what you are describing, it doesn't really sound like a vascular abnormality and mostly sounds like a nerve issue. It's possible you could have a small vascular anomaly there but I think it's pretty unlikely. While I appreciate the continued search, I doubt it will be that helpful for the symptoms that you have.
It sounds like you need a good neurologist to help you sort through these issues, so that's what I'd recommend.
@@LearnNeuroradiology appreciate the response. That's who is prescribing the scan. A neurologist. He's ruled out any real neurological issue like MS or Park. For years I keep being told it's muscle related. But every kind of muscle relaxer does nothing. It feels like my base of neck/upper spine is kinked on the right side, and that deep deep down in a tendon or where the deepest layer of whatever/something is trying to keep my neck stabilized, and it's causing this sensation and feelings. Nothing is sore to the touch, yet when I move it certain ways it does cause discomfort. And physical therapy neck exercises just makes it even worse.
I'm at a loss for how to keep trying to describe it and convey the mental anguish to doctors. Everyone keeps asking pain levels. It's not so much pain pain, that's only when I arch, move, angle my neck a certain way trying to get something, anything, to release, pop, move, shift, something. It's the puffiness, and sorta asleep feeling in my right side of face that is mentally painful.
That sounds very frustrating. I'm not sure that I can really help you because I'm not sure what it is. I suggest you continue working with your doctors to try to figure it out. Sorry again.
What’s the difference between a ct scan with contrast and a cta? Also can a ct scan pick up an unruptured anurysm
The difference is the timing. A CTA is specifically timed so most of the contrast is in the arteries (early) so that you can see them well, while a regular contrast CT is more delayed so you could see anything enhancing in the brain tissue.
You might be able to see an aneurysm on a contrast CT, but it's not as good at finding them, especially if they are small.
@@LearnNeuroradiology I’ve been having all the symptoms of an unruptured anurysm, extreme pain behind my eye, numbness on one side of my face, vison is blurry, pressure, pain in my head when bending over, headaches etc..they did a ct scan and said they never found anything. Do you think I should ask for a cta or mra just to be sure? I’m so worried I could have a ticking time bomb waiting to go off in my head 😫
Well, I think you have to talk about it with your doctor. Unruptured aneurysms very rarely have symptoms at all, although they can sometimes bleed a little bit and cause symptoms. If you are concerned and you share that with your doctor, they may want to get an MRA or CTA to see and it may reassure you that nothing is wrong.
Dr please .. i live in Egypt .. id like to ask .. is normal x ray with contrast is enough to show all blood vessels in the left temporal lobe? because cat scan is harmful and i cannot afford MRI . Please reply me .
No, a regular x-ray with contrast is not enough to show left temporal blood vessels. You would need either:
- a catheter angiogram
- a CT angiogram
- an MR angiogram
Of these, CT is often the fastest, cheapest, and most widely available. A catheter angiogram may cost more and is certainly more invasive.
All of this depends on the reason you need the exam though to see which one is best.
@@LearnNeuroradiology ty
Hi , hope you are well . May I please ask a question. If there is an aneurysm in a condylar vein is that important to report it or should it be ignored by radiologists?
Venous outpouchings are probably better referred to as diverticula and are rarely clinically relevant. They are extremely common and unlikely to have pathology associated with them.
One exception would be a jugular vein diverticulum in the temporal bone which may be associated with tinnitus.
Thanks so much I really appreciate it and you are very kind to reply so quickly. Thanks
One of the best voices I've ever come across.
Can you show a carotid web?
Great idea. I'll try to find a good example for an upcoming video.
@@LearnNeuroradiology you can use mine!😆
🤯
I think I probably have one but amazing! I hope you are doing well and thanks for checking out the videos!
Sound is too low.
Hi ! Would you please help,' my two year old child done craniopharyngioma operation and find low grade astrocytoma in CT after operation help sir thanks in advance
I'm sorry to hear that your child had a tumor resected. I hope they are doing ok now.
To answer your question, most of the time you would not diagnose a low grade astrocytoma on a CT, but instead an MRI. I think you probably need to ask your doctors specifically what was seen on the scan and what the next steps are. Sorry to not be more helpful but it's hard to guess what they actually meant.