Question 2124
{"accessible":false,"alternatives":[{"id":10551,"text":"CT angiography: arterial phase only of the head and neck"},{"id":10552,"text":"CT angiography: arterial phase of the head and neck plus venous phase of the head"},{"id":10553,"text":"CT of the head and neck with contrast (brain parenchymal/soft tissue phase)"},{"id":10550,"text":"MRI brain without contrast, MR angiography of the head without contrast, MR angiography of the neck with contrast plus axial T1 precontrast with fat saturation at the skull base, and MRI of the cervical spine without contrast"},{"id":10549,"text":"point-of-care ultrasound of the carotid arteries and jugular veins"}],"archived":false,"correctAlternativeId":10552,"explanation":"\u003cp\u003eThe patient meets the criteria for screening for \u003ca href=\"/articles/blunt-cerebrovascular-injury\"\u003eblunt cerebrovascular injury\u003c/a\u003e, including neurologic deficits not completely explained by\u0026nbsp;head CT findings and the presence of basilar skull fracture involving the petrous temporal bone, even without a clear involvement of the carotid canal (see the\u0026nbsp;\u003ca href=\"/articles/denver-criteria-for-blunt-cerebrovascular-injury-1\"\u003eDenver criteria\u003c/a\u003e\u0026nbsp;and\u0026nbsp;\u003ca href=\"/articles/modified-memphis-criteria-for-blunt-cerebrovascular-injury\"\u003emodified Memphis criteria for blunt cerebrovascular injury\u003c/a\u003e). In addition, the fracture courses to the \u003ca href=\"/articles/sigmoid-plate\"\u003esigmoid plate\u003c/a\u003e, which seats the sigmoid sinus and carries the risk of traumatic \u003ca href=\"/articles/dural-venous-sinus-thrombosis\"\u003edural venous sinus thrombosis\u003c/a\u003e. CT angiography of the head and neck with venous delays of the head would be the optimal protocol to assess for both injuries to the carotid and vertebral arteries and for thrombosis of the dural venous sinuses.\u003c/p\u003e\u003cp\u003eUltrasound is insensitive for detecting blunt cerebrovascular injury. MRI is suboptimal in this clinical context due to the long time required. CT with contrast, performed in the soft tissue equilibrium phase, is inadequate to evaluate the arteries due to suboptimal opacification.\u003c/p\u003e","id":2124,"imageUrl":null,"imageAttribution":null,"imageAttributionCaseInfo":null,"firstQuestionPath":"/questions/2966","nextQuestionPath":null,"relatedArticles":[{"id":18477,"title":"Non contrast enhanced MR angiography","link":"/articles/non-contrast-enhanced-mr-angiography-1?lang=us"},{"id":51177,"title":"Ultrasound carotids (summary)","link":"/articles/ultrasound-carotids-summary?lang=us"},{"id":42089,"title":"CT cerebral venography (protocol)","link":"/articles/ct-cerebral-venography-protocol?lang=us"},{"id":57590,"title":"CT angiography of the cerebral arteries (protocol)","link":"/articles/ct-angiography-of-the-cerebral-arteries-protocol?lang=us"},{"id":90090,"title":"CT neck (protocol)","link":"/articles/ct-neck-protocol-1?lang=us"}],"alsoUsedIn":[{"id":986,"kind":"Course","title":"2021 Virtual Conference Private Use - page 986","link":"https://radiopaedia.org/courses/2021-virtual-conference-private-use/pages/986"},{"id":986,"kind":"Course","title":"Radiopaedia 2021 - isoCME - page 986","link":"https://radiopaedia.org/courses/radiopaedia-2021-isocme/pages/986"},{"id":986,"kind":"Course","title":"2022 Virtual Conference Private Use - page 986","link":"https://radiopaedia.org/courses/2022-virtual-conference-private-use/pages/986"},{"id":970,"kind":"RestrictedPage","title":"Page 970 (in no courses)","link":"https://radiopaedia.org/admin/restricted_pages/970"},{"id":955,"kind":"RestrictedPage","title":"Page 955 (in no courses)","link":"https://radiopaedia.org/admin/restricted_pages/955"},{"id":1,"kind":"LiveSchedule","title":"1","link":"https://radiopaedia.org/admin/live_schedules/1"},{"id":19,"kind":"LiveSchedule","title":"19","link":"https://radiopaedia.org/admin/live_schedules/19"},{"id":919,"kind":"Course","title":"2021 Virtual Conference Private Use - page 919","link":"https://radiopaedia.org/courses/2021-virtual-conference-private-use/pages/919"},{"id":919,"kind":"Course","title":"Radiopaedia 2021 - isoCME - page 919","link":"https://radiopaedia.org/courses/radiopaedia-2021-isocme/pages/919"},{"id":919,"kind":"Course","title":"Head \u0026 Neck Lectures - page 919","link":"https://radiopaedia.org/courses/head-neck-lectures/pages/919"}],"stem":"\u003cp\u003eA patient without prior medical history was\u0026nbsp;involved in a motor vehicle collision and arrives obtunded. The patient\u0026nbsp;undergoes noncontrast CT of the head and cervical spine. At the acquisition scanner, you identify scattered convexal subarachnoid hemorrhage and\u0026nbsp;fractures of the right petrous temporal bone, characterized as otic-capsule sparing, coursing to the sigmoid plate, and not clearly involving the petrous carotid canal on that side. Based on this information, which of the following imaging tests is the most appropriate next step?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/2124"}],"attemptsPercentages":[{"alternativeId":"10553","percentage":5},{"alternativeId":"10551","percentage":15},{"alternativeId":"10550","percentage":8},{"alternativeId":"10549","percentage":2},{"alternativeId":"10552","percentage":70}],"promptToLogin":false,"questionManager":false,"articleId":"contrast-enhanced-mr-angiography"}