RadteraCTA Head and Neck
CTA+ ContrastNeuro
Indications
- Acute stroke workup: detection of large vessel occlusion and tandem lesions
- Carotid/vertebral artery stenosis or dissection; TIA
- Intracranial aneurysm, AVM, vasculitis, vasospasm
- Blunt/penetrating cerebrovascular injury screening
Patient prep
- 18-20G IV antecubital (right arm preferred to reduce streak from contrast in left brachiocephalic vein)
- Assess renal function in non-emergent settings; emergent stroke does not delay
- Remove jewelry/dentures from field
Contrast
Agentiodinated (iohexol/iopamidol ~350-370 mgI/mL)
RouteIV
Dose60-90 mL at 4-6 mL/s + saline chase
TimingBolus tracking with ROI in aortic arch/ascending aorta (trigger ~100-150 HU) or test bolus; arterial phase from aortic arch through circle of Willis/vertex
Technique
- Supine, head in holder, chin tucked, arms down for neck coverage
- Coverage from aortic arch to vertex
- 120 kV (or 100 kV for thinner patients to boost iodine signal); dose modulation
- Thin-section helical, sub-mm collimation, 0.5-0.75 mm recon for reformats
- Bolus tracking critical to capture arterial phase before venous contamination
- Often performed immediately after non-contrast head +/- perfusion
Series / Sequences
| # | Series / Sequence | Plane | Thickness | Notes |
|---|---|---|---|---|
| 1 | Axial arterial source | axial | 0.5-1 mm | Thin source for 3D |
| 2 | Axial thick | axial | 2-3 mm | Review images |
| 3 | Coronal/Sagittal MIP | coronal/sagittal | 5-10 mm MIP | Neck vessels |
| 4 | Circle of Willis MIP/3D | multiple | MIP/VR | Intracranial vasculature |
| 5 | Curved/oblique reformats | oblique | thin | Carotid bifurcation stenosis quantification (NASCET) |
Key points
- Single arterial acquisition from arch to vertex; mistiming causes venous contamination or poor arterial opacification
- Right arm injection reduces left brachiocephalic streak artifact obscuring origins of great vessels
- Quantify carotid stenosis by NASCET method on the axial/reformatted images
- Pair with non-contrast head and CT perfusion for comprehensive code-stroke workup
- Watch for dental amalgam streak degrading carotid evaluation; angled reformats help
References
• ACR-ASNR-SPR-SVS Practice Parameter for the Performance of CT Angiography of the Extracranial and Intracranial Arteries
• Radiopaedia: CT angiography of the head and neck ( link
• ACR Appropriateness Criteria: Cerebrovascular Disease
• Radiopaedia: CT angiography of the head and neck ( link
• ACR Appropriateness Criteria: Cerebrovascular Disease
Source: Researched — verify against your institution
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Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.