This is an education resource only. Ordering of all procedure codes on this website are subject to the Canberra Health Services guidelines for imaging orders.
INDICATIONS (1-5)
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Ischaemic stroke to diagnose occlusion and thrombosis / assess change and monitor known cases
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Carotid artery dissection
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Vertebral artery dissection
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Arterial vascular malformation within the head and neck
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Transient ischaemic attack, used to evaluate carotid artery stenosis as potential causation
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Subarachnoid haemorrhage to assess aneurysmal origin
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Cerebral parenchymal haemorrhage, to assess for the presence of a vascular malformation or ongoing bleeding (spot sign)
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Vascular trauma
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Suspected vasculitis/fybromuscular dysplasia (FMD)/reversible cerebral vasoconstriction syndrome (RCVS)
PATHOLOGY DEMONSTRATED (6)
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Occlusion and thrombosis within the carotid and vertebral arteries
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Carotid artery dissection
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Vertebral artery dissection
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Arteriovenous malformation within the head and neck
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Carotid artery stenosis
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Aneurysms within cerebral and neck vasculature
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Acute haemorrhage (spot sign)
PATIENT PREPARATION
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Patient able to lie still for ten minutes
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Not claustrophobic (sedation may be given)
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Cognitively capable of following basic instructions
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Metal artefacts removed from the region of interest
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No respiratory distress when lying supine
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Not allergic to Iodine based Contrast
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No known kidney disease (eGFR below 30 as per RANZCR), however, acute setting consultant may sign to continue with poor renal function
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No hyperthyroidism, may induce thyroid storm
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Patient to have 18G cannula in anterior cubital fossa to enable a 7ml/s flow rate (20G cannula acceptable if flushing to 5ml/s).
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Preferably patient fasted for 4 hours
ANATOMY INCLUDED
CT Brain - Non Contrast (Axial)
Angiography Arch to COW (Axial)
CT Brain - Non Contrast (Coronal)
Angiography Arch to COW (Coronal)
CT Brain - Non Contrast (Sagittal)
Angiography Arch to COW (Sagittal)
REFERENCES
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Radiopaedia. CT Angiography of the Cerebral Arteries (technique). [Internet]. 2018. [Updated 01 Jul 2021, cited 29/12/2021]. Available from https://radiopaedia.org/articles/ct-angiography-of-the-cerebral-arteries-technique
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American College of Radiology (ACR). Appropriateness Criteria. [Internet]. 2022 [Updated 2021, cited 23 Nov 2021]. Available from https://www.acr.org/Clinical-Resources/ACR-Appropriateness-Criteria
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Anderson GB, Ashforth R, Steinke DE, Ferdinandy R, Findlay JM. CT Angiography for the detection and characterisation of carotid artery bifurcation disease. Stroke 2000; 31 (9), 2168-2194.
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Harrison MJ, Marshall J. Indications for angiography and surgery in carotid artery disease. BMJ 1975; 1 (5958), 616-618.
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Sullivan TM. Current indications, results, and technique of carotid angioplasty/stenting. Semin Vasc Surg 2005; 18 (2), 87-94.
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Eisenberg RL., Johnson NM. Comprehensive Radiographic Pathology. 5th Edition. Elsevier Mosby, 2012.