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CTA Head and Neck

TECHNIQUE: Standard noncontrast head CT. Post IV contrast thin section
transverse images through the neck during the arterial phase of contrast
enhancement. Images were reformatted in coronal and sagittal planes.

COMPARISON STUDY: MRI TIA stroke protocol study from 9/11/2013.

Aortic arch: There is a normal anatomic branching pattern of the 3 arteries
from the top of the aortic arch, without flow limiting lesions. There is
mild atherosclerotic ectasia visualized within the ascending aorta and
aortic arch.

Carotid arteries:
Right common and internal carotid: The innominate trunk is patent. There is
heavily calcified atherosclerotic plaque within the distal common carotid
artery extending into the proximal internal carotid artery with focal right
ICA origin severe stenosis (greater than 90%). The remaining portions of the
right common and cervical internal carotid arteries are patent. There is
mild atherosclerotic stenosis of the distal internal carotid artery at the
cavernous segment secondary to heavily calcified atherosclerosis. There are
no aneurysmal dilatations.

Left common and internal carotid: There is mild atherosclerotic stenosis of
the distal internal carotid artery secondary to atherosclerotic plaque.
There are few very small atherosclerotic excavations in the left proximal
internal carotid artery without flow limiting disease. The left common and
internal carotid arteries are otherwise unremarkable.

Vertebral arteries: There is mild osseous remodeling in the lower cervical
spine within the transverse foramina secondary to degenerative osteophytic
disease, however, there are no flow limiting lesions within the vertebral

Circle of Willis and intracranial arteries: There is a calcified
atherosclerotic plaque in the cavernous carotid arteries, without evidence
to suggest flow-limiting disease. There is no aneurysm or evidence of
vascular malformation. Incidental note is made of apparent post
embolization coils in the right pterygomaxillary fissure at the region of
the internal maxillary artery, of uncertain clinical significance.

Other: Noncontrast CT images through the head demonstrate no hemorrhage,
mass effect or herniation. There are chronic microangiopathic ischemic
changes in the supratentorial white matter, and diffuse brain parenchymal
atrophy which are likely consistent with senescent changes.

Images through the cervical spine demonstrate multifocal spondylitic
changes and degenerative disc disease more pronounced in the lower cervical
spine. There are no acute or aggressive osseous lesions.

Limited views of the lung apices are unremarkable. The remainder of the soft
tissues are unremarkable.

1. Severe (greater than 90%) short segment stenosis of the right distal
common and proximal right internal carotid artery secondary to heavily
calcified atherosclerotic plaque.
2. No other evidence of flow-limiting atherosclerotic disease in the neck or
Comparison: Multiple prior head CTs, most recent was on 18 of September

Technique: Noncontrast CT images of the head were performed. CT angiogram
images of the head and neck were then obtained following the uneventful
administration of 100 cc Isovue. Multiplanar reformatted images were

Findings: Given variations in technique, there is no significant change in
the previous described region of encephalomalacia involving the left
parietal lobe consistent with the history of prior infarct in this region.
Mild diffuse enlargement of the extra axial CSF spaces likely related to
volume loss, slightly increased from the prior exam. Scattered hypodensity
in the periventricular white matter is likely related to small vessel
ischemia. Postoperative changes, status post left parietal craniotomy are
stable. There is no evidence of loosening of the craniotomy hardware. Left
parietal dural based aneurysm clip is again identified adjacent to the
posterior margin of the craniotomy site. Focal metallic artifact in the
right parietal scalp is unchanged from the prior study. Correlate with
surgical history.

Evaluation of the circle of Willis demonstrates a patent vertebrobasilar
system without evidence of aneurysm or stenosis. Dense atherosclerotic
calcifications are noted in the cavernous carotid arteries without
significant stenosis. There is no evidence of
intracranial stenosis or aneurysm. Mild asymmetry of the MCA bifurcations is
again noted but stable from the prior CT dated 26 August 2008 and is of
doubtful clinical significance. There is no definite residual dural AV
fistula however CT scan is limited in the evaluation of dural AV fistula.
If there is persistent concern, catheter angiogram can be performed.

Evaluation of the soft tissues of the neck again demonstrate enhancing
masses within the bilateral parotid glands. Given variations in technique,
these are unchanged in size from the prior study dated August 26, 2008 and
may represent intraparotid lymph nodes versus other benign parotid lesions.
Stability over time argues against a more aggressive process. There is a
normal vascular enhancement within the vessels of the neck without focal
stenosis or aneurysm. Minimal atherosclerotic calcifications are noted in
the carotid bulbs bilaterally.

There is a nodular prominence of the inferior aspect of the thyroid gland
with heterogeneous density which extends substernally. Visualized lung
apices are clear. Minimal atherosclerotic calcifications are noted in the
aortic arch.

Diffuse degenerative changes are present in the cervical spine with variable
canal and foraminal stenosis. No aggressive lytic or blastic osseous lesion
is noted.

1. Stable exam. Senescent changes and old left parietal infarct without
evidence of acute intracranial pathology.
2. Postoperative changes status post dural AV fistula repair. There is no
definite residual fistula however catheter angiogram is more sensitive in
the evaluation of small fistulous connections.
3. Enhancing parotid nodules bilaterally, stable from prior CT scan dated 26
August 2008. Stability over time argues against an aggressive process.
Differential includes intraparotid lymph nodes versus benign parotid
4. Substernal extension of thyroid gland. Other chronic findings as above.