Non-invasive imaging of the cervical carotid and vertebral arteries

Disease at the carotid bifurcation is most commonly owing to atherosclerosis. Trial data indicate that intervention is beneficial for patients with high grade symptomatic stenoses. Cerebral angiography remains the reference standard, but is invasive. In experienced hands, colour duplex ultrasound is able to reliably grade stenoses and is also able to give information about plaque morphology. A variety of techniques may be used to produce MR angiograms to reliably image the carotid system from the aortic arch to the Circle of Willis Carotid dissection tends to affect a younger age group and is best imaged with a combination of duplex ultrasound and MR angiography.