By Jorge Soto, Brian Lucey

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These noninvasive techniques are very useful for follow-up of dissection as a result of the lack of ionizing radiation or the need for injection of a contrast agent. CTA shares many of the advantages of MRA and provides higher spatial resolution. Another specific sign reported by CTA is the “target” sign, which is composed of a thickened wall and a narrowed eccentric lumen surrounded by a thin rim of contrast enhancement. CTA is certainly the fastest way to screen patients in the emergency setting Intracranial arteries lack an external elastic lamina and have thinner media and adventitia compared with extracranial vessels, and thus intracranial dissections may behave differently.

CTP applied in the setting of acute stroke has been validated with clinical outcomes and follow-up imaging and also by comparison with DWI. 5 mL/100 g be considered the “core infarct” and regions with a CBF reduction of more than 34% be defined as the penumbra. These values were based on correspondence with initial DWI abnormality and final infarct size. Schaefer and colleagues later proposed other absolute values and the use of normalized CBV and CBF ratios to help distinguish ischemic tissue likely to become infarcted from that likely to survive after intraarterial recanalization therapy.

A, A volume-rendered image from a computed tomography (CT) angiogram shows a comminuted mandibular fracture (arrows). The internal jugular vein obscures the internal carotid artery. B, A 180-degree rotation and application of an anterior cutting plane reveal tapered contour of the internal carotid artery (arrows) as a result of dissection. C, Multiplanar reconstruction from a follow-up CT angiogram 1 week later shows development of a small pseudoaneurysm (arrow) with residual, mild, distal stenosis.

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Emergency Radiology by Jorge Soto, Brian Lucey


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