Had my CTV done but not sure it came out well. I took the script from Dr. Constantino to my local University Radiology (they are the area’s imaging providers) and the tech said there is a mistake on the script. She called their neuro-radiologist to make some changes and I had the test done.
Not sure what the “issues” were. Seemed the script was pretty clear: “CTV of the head and neck with 3d reconstruction, measure the length of the styloids” The reports that I got back said that they did a CT Angiogram. I don’t know if there is a difference between an angiogram and a venogram…does anyone?
Also the imaging is a little wierd…looks like some of the structures got cut off with blocks of black squares on the images themselves. Compared to some of the CTV’s I’ve seen on this site, mine look very low quality and resolution. I would have thought that the styloids would have been clearer and the juglars and corortids shown clearer…but I don’t know.
The styloids only show at the tips in the 3d image…they cut out as you rotate and can’t see them from the sides which is what I was hoping for since it is 3D afterall.
My hyoid is very crooked and I want to ask about that when I follow up. Also from the rear, I thought I’d be able to see the veins clearer in the back of the neck. You can see the left styloid, but not really much else.
The Neck CT Angiogram report states: Left styloid measures 5.3 cm, and Right styloid is 4.7 cm long. Elongated Left styloid touches the lateral wall of the left internal carotid artery at c2-c3. There is no displacement or compression of this artery. No significant stenosis of the major neck arteries.
The Brain CT Angiongram report states: Small dilated cardiovascular space noted in the dorsal right basal ganglia measuring 6x4mm. Under the findings for the Circle of Willlis it says Right posterior communicating artery: no contrast seen along expected course. Normal CTA of Brain.
I’ve looked up these terms and not sure what they mean exactly but will ask about it. I think going forward I am going to ask the doctors if they have a recommended radiology facility that they work with. I am hoping that my study was done properly and of good enough quality - I’m getting expsoure everytime I have a CT and don’t know how many more I’ll need for the CCI workups.
The “mistake” may have been that a CTV was requested as opposed to a CTA. Some radiology labs think they’re one & the same or will tell you they can’t do a CTV. We’ve had other members run into this issue. I would say based on the focus of their findings, which was only the styloids & ICAs, they did indeed do a CTA & not a CTV as there is no discussion re: IJVs in the radiology report.
In all of your images, your left internal jugular vein appears to be completely absent. This is unusual but not unheard of. From the images you’ve posted, it’s unclear whether your right IJV is being compressed by your styloid pressing it against your C1 vertebra. It does look quite large, but that may be due to the fact it’s your dominant & only IJV & is bearing the burden of all the blood outflow from your brain.
I think the images are fine. Maybe not as clear as others you’ve seen but plenty good enough to see what’s needed.
I agree about your hyoid being crooked, & I’ll add that the stylohyoid ligaments are calcified a bit on both of your lesser hyoid horns w/ it being more pronounced on the right. See annotations below:
Based on this information, your styloids are significantly elongated so are likely contributing to your symptoms & overall neck discomfort. The fact that the left styloid is contacting your left ICA can cause irritation to the ICA even w/o significant stenosis. That irritation can produce symptoms consistent w/ ICA compression such as TIAs, numbness on the left half of your face, left lip or eye droop, etc. If you don’t have those symptoms then the radiology report’s suggestion that the contact is insignificant is likely correct.
This is good news. I’m sorry but I can’t translate the information about what the brain part of the CTA says.
Something else I noted is that your ICAs & ECAs on each side are twisted around each other., especially on the right side. I don’t know how common that is or if it has any significance as regards your symptoms, but it is an interesting finding.
Finally, I also noted your C1 vertebra is not level. It’s not terribly off but is tilted in the same direction as your hyoid bone i.e. the left side is lower than the right. It would be interesting if Dr. Costantino thinks there’s a connection.
When a CT is done with contrast, the CT images can be timed to see as the contrast goes through the arteries to the brain (CTA), and as it goes out through the veins (CTV), your imaging does show both, so hopefully there’s enough for Dr C to work with…
I agree with @Isaiah_40_31 , your styloid on the left is massive, & the right long with a calcified ligament. I can’t see a left IJV at all, so if your right is being compressed between the C1 process and the styloid then that will more than likely cause issues! I can’t recall seeing a hyoid bone as tilted as yours, and the processes look pretty thick too. And the styloids being close to the carotid arteries shows too…hopefully it’s good enough for Dr C & you won’t need any more imaging!
For your CCI assessments though, MRI’s are usually done for that, so you won’t be exposed to any more radiation…
I did look at the image @Isaiah_40_31 and not sure if they are twisted, kind of look like it, but if I zoom in on the posted picture there is a shadow that might mean they are not twisted, but just look that way from the front. I traced your lables down each branch and I think they are not twisted, but not sure. I would guess that the Dr. will look at it and I will bring up your point to him and ask about that.
I go for a weight bearing MRI upright with flexion/extension this Thursday so will have some more image to share.
Thx for your input, @Disabled_Inventor. I’m not a doctor & have made wrong observations before. I noted there is probably not any significance to the positions of the internal & external carotids. The fact that they look a bit twisted was just an observation.
It’s good that you have your upright MRI coming up soon. I look forward to seeing the pictures you post.
Just to be safe I sent the screen shots and reports over to Dr. Constantino’s office with my concerns asking if they have what they need or if they want it redone before the follow up visit. Figured its best to send an email than drive all the way there to find out.
I had my flexion/Extension mri and will look at it soon and upload some shots. IT was a very good experience, wasn’t as bad as I thought it would be, but they did have me stabilized with bars so that I wouldn’t so I didn’t sucum to vertigo or fainting.
I’m glad the upright MRI is done, & you’re smart to send the the screen shots & reports to Dr. Costantino ahead of time to get his opinion. I suspect he’ll want to look at the scan slices vs the 3D images though, as most doctors rely on the slices vs the images that are easier for us to understand.
