Correct type of scans to order and what to note for radiologist

General
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Hi all. I am hoping to confirm the best types of CT scans to have my PCP order ahead of my appointment with Dr. Hepworth in May. My PCP sent in an order for a dynamic CTA of the neck w/ and w/o contrast, which I have scheduled for this coming Monday.

My last CT (regular/non-dynamic) was done in 2018 and was of facial bones and skull; I have been trying to get a disk copy of this scan but haven’t had any luck. And even if I succeed in obtaining a copy, that scan is obviously outdated so not sure how helpful it will be at this point. The 2018 scans did show that I had bilateral elongation of styloid/hyoid process/ligaments. I also had a panoramic Xray done in 2021 and am waiting to receive the requested copy.

So my questions are:

  1. Are there things that can only be seen in a regular CT, compared to a CTA? In other words, might a CT still be needed in conjunction with the CTA my dr ordered?

  2. Will the CTA of the neck be sufficient? I have seen other recommend scans of neck + facial bones/skull, so not sure if I should ask my PCP to modify the order.

  • Perhaps important to note that I was diagnosed in 2018 with stable/non-active, but severe arthritis in both TMJs, so I suppose it would be beneficial to have CT done of facial bones / skull to determine whether the arthritis is still stable/non-active or if more degeneration has occurred.

  1. Are there any notes I should ask my PCP to send for the radiologist? I am most interested in findings related to ES, of course, and/or VES, along with HBS and CCI (though I am unsure if anything related to CCI can be determined via a CT scan).

  2. I saw a neurologist in December who ordered a brain MRI. Is it worth it to get this done? Insurance did approve it.

Thanks in advance!

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Since your CTA is w/ & w/o contrast, it will show your styloids & the vascular tissues the styloids may be compressing especially since you said it’s scheduled to be a dynamic scan. I assume the scan is covering the area from skull base to hyoid bone. You can ask for the radiology report to comment on styloid lengths, calcification of stylohyoid ligaments & stylomandibular ligaments as well as the lengths of the greater horns of your hyoid bone if they appear longer than normal.

You should not get any other scans before seeing Dr. Hepworth as he will specifically order anything else he wants after seeing your CTA.

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@Rlr286 the CTA is primarily for arteries (A). My cardiologist ordered a CTA with and without contrast, but my biggest issue was with the internal jugular vein, which was not addressed by the CTA. A CTV is needed for that. The radiologist did not even mention my styloids on the first report, so I had a small battle with the radiology department to have the CTA re-evaluated by a neuroradiologist who knew what to look for.

A normal CT scan with and without contract of the neck and maxillofacial area will provide adequate information to identify issues with veins and arteries that may be in proximity of the styloids. MRIs are not useful for visualizing styloids. It is possible to see small parts of the styloids with MRI, and vascular compression, but it is really a challenge to measure styloids with MRI, or determine their path.

Be sure and bring a disk of the CT home with you so you can look at the images yourself. Radiologists in my area identify big features but have not given complete reports regarding my styloids ever.

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