Existing options to evaluate cerebral vessels
What options exist for evaluating cerebral vessels?
Carotid duplex ultrasound is cost-effective but inadequate for evaluation of intracranial vessels or the posterior circulation.
Transcranial Doppler ultrasound evaluates intracranial vessels but is operator dependent and not widely available.
CT angiogram is fast, readily available, and provides detailed information from the aortic arch to the intracranial vessels.
Disadvantages include radiation exposure and the need for iodinated contrast. MR angiogram also evaluates the entire cerebrovascular tree, although motion artifacts can obscure the arch and great vessel origins.
Its major disadvantage is the need to lie still for 30 to 45 minutes.
Gadolinium-based contrast agents provide additional resolution but cannot be given in renal insufficiency due to the possibility of systemic sclerosis.