0:01

How do we image the carotid space?

0:03

For the most part,

0:04

we're going to be using contrast enhanced CT scan

0:07

and we're going to be acquiring with thin sections

0:09

so that way we can do multiplanear reconstructions.

0:13

On some of the cases where the pathology

0:15

is in the blood vessels,

0:17

for example the arteries or the veins,

0:19

we will use a CTA or CTV technique timed

0:24

to the bolus of the contrast.

0:26

Often we will be using three dimensional

0:28

reconstructions,

0:29

particularly when we're doing presurgical evaluation

0:32

of a lesion in the carotid space.

0:35

On MRI, we're using our neck protocol.

0:38

The neck protocol requires you to have very

0:41

good fat suppression techniques. For some,

0:44

that can be using frequency selective fat

0:48

suppression techniques. But for most people,

0:50

they use inversion recovery fast spineko T,

0:54

two weight scans in order to invert at the fat

0:57

frequency and cause the neck to have dark.

1:01

Signal T one weight scans without fat suppression

1:05

are excellent because the fat that is bright on a T

1:08

one weight scan provides excellent contrast with

1:12

which to see an intermediate

1:14

signal intensity lesion.

1:16

We do postgatolinium enhanced scanning

1:18

in the Mr sequences,

1:21

again using fat suppression in order to highlight

1:24

whether a lesion is enhancing or not.

1:27

If the lesion is small or at the skull base,

1:30

we will convert the study into

1:31

our skull based protocol,

1:33

which uses Fin section Fiesta or CIS imaging.

1:37

That's the very high resolution T two weighted

1:42

sequencing. Or we'll use the Vibe imaging,

1:45

which is analogous thin section

1:47

T one weighted imaging. Again,

1:50

the fat suppression is very important because it can

1:53

lead to a lot of artifacts that can obscure detail

1:56

and the pathology and therefore make sure that

1:59

you're using whatever fat suppression technique,

2:02

be it Dixon,

2:04

be it version recovery or frequency selection

2:07

that works best on your scanner.