Type of CT for VES

Believe this is from Isaiah …

"A CT with contrast is generally used to diagnose vascular ES (compression of the internal jugular vein or internal carotid artery by the styloids).

Since a CT w/ contrast shows soft tissues as well as bony structures, it can be harder to determine styloid length & other features of the styloid that might cause symptoms as the soft tissues can partially cover the styloids & s-h ligaments."

Assume since I have vascular symptoms need CT w contrast as a higher priority over possibility of not getting good images of styloid and ligaments? (of course trying to reduce radiation exposure and need for additional CT).

Thank you

I think if you have Vascular symptoms the best scan would be a CT with contrast- ideally if symptoms are worse with a particular neck position if you could have it done like that, but that’s not always possible…It should still show the styloids & any calcifications well enough.


thank you so much! regarding positioning … is it something the ordering dr puts on the order?

From another post …

temporal styloid processes
To support our hypothesis of a stylocarotid impingement, a cervical CTA with hyperflexion (45°) of the neck was performed. It clearly revealed the bilateral impingement between the styloid processes and internal carotids.

Head position during a CT can also affect the extent to which the jugular veins are compressed. A neutral head position can reveal that nothing is wrong whereas having the head turned one way or the other, or up/down, can tell a different story. Again, being able to have your head in the position that causes symptoms to be more pronounced is the key. If a CT w/ contrast doesn’t show vascular compression of any sort, a follow-up angiogram can be done to check blood flow volumes through the veins/arteries. These can be done w/ the head in the position that provokes symptoms.

I’m not sure whether your symptoms are indicating IJV vs ICA compression. A CT scan can be done both w/o contrast & w/ in one scan session. It must be requested by the prescribing doctor though.

Interesting … ok good to know. Will ask to amend the order to both with and without contrast if they can.

Since I do have an appt with an interventional vascular neuro … they will do the angio if needed… and timing wise, I should have ct results back before both appointments (skull base surgeon and vas neuro). TY

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I should have said, a CT or other scan/test that checks for compression w/ the head in different positions is called dynamic testing. A test w/ head in neutral is static testing.