E3426. Multimodality Vascular Imaging of the Neck: What the Radiologist Needs to Know
  1. Eric Abshire; Henry Ford Hospital
  2. Sreenavya Gandikota; Wayne State University
  3. Cal Riutta; Michigan State University
  4. Arafat Ali; Henry Ford Hospital
Vascular pathology in the neck can be devastating and often requires fast and accurate recognition by radiologists. This requires an understanding of the various imaging modalities that are used to visualize the cervical vasculature as well as a familiarity with the different pathologies that can occur. This exhibit will review strengths and weaknesses of CT, MRI, and ultrasound in diagnosing vascular pathology in the neck with a brief discussion of the important imaging considerations of the most common diagnoses.

Educational Goals / Teaching Points
The first goal of this exhibit is to familiarize the reader with the various techniques for imaging neck vasculature using CT, MRI, and ultrasound. There will be a review of the common pathologies that occur with examples images across the various modalities. We will compare the strengths and weaknesses of the different modalities as they relate to the specific diagnoses. We will also review the important reporting considerations that the clinicians are looking for to ensure optimal care.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
To achieve the above goals, we will discuss the imaging of cervical steno-occlusive disease, trauma, vascular malformations, tumors, steal phenomenon, and cartidynia. We will also go into detail regarding the differences and tradeoffs between time-of-flight magnetic resonance angiography (MRA) and time-resolved contrast-enhanced MRA. Additionally, we will describe the methods used for MRI imaging of vessel walls and contrast-enhanced imaging of tumors in the neck. Finally, there will be a brief discussion on impact of the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and subsequent trials on the current management of steno-occlusive disease.

There are several important vascular pathologies that occur in the neck which can have devastating consequences and must be diagnosed quickly and accurately. There are also several different ways to image these conditions, each with their own pros and cons. As radiologists, we must be familiar with both the conditions and the imaging methods to provide the best possible care.