I have orders for a CTV (contrast-only) head and neck venous phase to check for stenosis / compression and Vascular Eagles. I will be doing a cerebral angiogram next month.
Some questions:
Will just the CTV neck venous phase show Vascular Eagles / IJV compression or do I also need the CTV head for this diagnosis? I’m thinking that the CTV head is more for intracranial issues and that can be seen with the cerebral angiogram. CTV head will just add more radiation.
Will a cerebral angiogram with venous phase be able to detect jugular stenosis?
@chrEagle - A CTV of the neck from skull base to hyoid bone is enough to visually see IJV compression in the neck. An angio/venogram will help determine if there is compression of any vessels in your brain, as well as be able to measure pressure gradients between compressed & non-compressed areas, however, it’s not done w/o radiation as the contrast used for that is also radioactive as the angio/venogram is done under a fluoroscope.
I don’t know how much difference there is between the radiation you receive in a CT scan vs an angiogram. CT scans are much safer from the standpoint that they’re non-invasive whereas the angio/venogram involves a catheter being run up into your brain through a vein or artery which has it’s own potential problems. A stroke or brain bleed are possible complications though they are rare.
An MRV will also show IJV compression & collateral veins that have formed to bypass the IJVs, however, the contrast used for those is gadolinium based & some people have had long-term problems from the gadolinium. All that to say that all of this testing has risks as well as benefits.
You mentioned “A CTV of the neck from skull base to hyoid bone”
Is this from below the jugular bulb? Or does it also capture the transverse-sigmoid junction, sigmoid sinus and jugular bulb area in addition to the internal jugular veins?
I am trying to avoid adding more radiation with the CTV head, but I need the distal sigmoid sinus and jugular bulb area captured.
No venogram is planned – only angiogram with venous phase. I have had a no-contrast MRV of the head which did not show the sigmoid sinus/jugular bulb clearly on one side – possible turbulent or slow blood flow.
I think in most cases, the jugular bulb is visible in a skull base CT scan as it’s where the IJV enters the skull but just outside of the skull, however, the sigmoid sinus & transverse-sigmoid junction are inside of the skull so would need to be viewed by a skull CT. That said, you could have both done at once so you don’t need two separate CT scans.
I just had a CTV neck. Hospital scanned from Transverse Sigmoid junction all the way to the clavicle. So, they got the distal transverse sinus, entire sigmoid sinus, jugular bulb and IJV area.
I ran my images through AI and it says severe compression of right IJV at C1/styloid area - mostly C1. This matches the side of my symptoms. The neuro radiologist report however did not see this and looked at styloid/carotid/digastric muscle compression stating slight compression on the left hand side and nothing on the right hand side for styloid/carotid/digastric. Don’t know if C1 compression was missed.
That’s not very helpful, I think from reading your other post @TML is going to look at your images, so hopefully he can give you some suggestions of what’s going on (in a non professional but very thorough opinion obviously!)
Not sure why the hospital neuroradiologist did not comment on C1 compression. Maybe there is none. Or maybe they were focused on classic Vascular Eagles – what doc was looking for.
Unfortunately there’s no telling with radiologists, they often fail to comment on styloid processes when people have had CTs for neck pain, & their styloids are ridiculously long!