ACR–ASNR–SPR PRACTICE PARAMETER FOR THE PERFORMANCE OF COMPUTED TOMOGRAPHY ANGIOGRAPHY (CTA) OF THE HEAD AND NECK

PREAMBLE

I. INTRODUCTION

II. INDICATIONS

III. QUALIFICATIONS AND RESPONSIBILITIES OF PERSONNEL

IV. SPECIFICATIONS OF THE EXAMINATION

A. Patient Selection and Preparation

IV. SPECIFICATIONS OF THE EXAMINATION

B. CT Equipment

IV. SPECIFICATIONS OF THE EXAMINATION

C. Examination Technique

IV. SPECIFICATIONS OF THE EXAMINATION

D. Interpretation

V. DOCUMENTATION

VI. EQUIPMENT SPECIFICATIONS

VII. RADIATION SAFETY IN IMAGING

VIII. QUALITY CONTROL AND IMPROVEMENT, SAFETY, INFECTION CONTROL, AND PATIENT EDUCATION

ACKNOWLEDGEMENTS

Writing Committee – members represent their societies in the initial and final revision of this practice parameter

ACR
Joyner, David A MD, Chair
Isikbay, Masis BS, MD
Lasiecka, Zofia M MD, PhD
Maloney, John A MD
Ormsby, Jacob MBA, MD

ASNR
Lin, Doris D.M. MD, PhD
Nemeth, Alexander J MD
Segovis, Colin MD, PhD
Singhal, Aparna MD

SPR
Narayanan, Srikala MD
Powers, Andria MD
Radhakrishnan, Rupa MBBS, MS

Committee on Practice Parameters – Neuroradiology

(ACR Committee responsible for sponsoring the draft through the process)

Shah, Lubdha M MD, Chair	Aiken, Ashley H MD	Amrhein, Timothy J MD	Austin, Matthew J MD
Becker, Jennifer L MD	Blackham, Kristine A MD	Chaudhry, Umar S MD	Chiang, Gloria C MD
Hutchins, Troy A MD	Mazaheri, Parisa MD	Ormsby, Jacob MBA, MD	Riley, Kalen MD
Sio, Terence Tai-Weng MD, MS

Committee on Practice Parameters and Technical Standards

(ACR Committee responsible for sponsoring the draft through the process)

Caplin, Drew M MD, Chair

Committee on Practice Parameters – Pediatric Imaging

(ACR Committee responsible for sponsoring the draft through the process)

Amodio, John B MD, Chair	Alizai, Hamza MD	Bhimaniya, Sudhir X MBBS, MD	Blumfield, Einat MD
Collard, Michael MD	Goldman-Yassen, Adam MD	Lai, Hollie A MD	Lala, Shailee V MD
Lasiecka, Zofia M MD, PhD	Laufer, Adina MD	Li, Arleen MD	Maloney, John A MD
Noda, Sakura MD	Shah, Summit MD	Vatsky, Seth DO

Bulas, Dorothy I MD, Chair, Commission on Pediatric Radiology

Jordan, John E MD, Chair, Commission on Neuroradiology

Larson, David B MBA, MD, Chair, Commission on Quality and Safety

Comments Reconciliation Committee

Chen, Melissa MD - CSC, Chair	Chu, Sammy MD - CSC, Co-Chair	Amodio, John B MD	Bulas, Dorothy I MD
Caplin, Drew M MD	Crummy, Timothy MD, MHA - CSC	Isikbay, Masis BS, MD	Jordan, John E MD
Joyner, David A MD	Larson, David B MBA, MD	Lasiecka, Zofia M MD, PhD	Lin, Doris D.M. MD, PhD
Maloney, John A MD	Narayanan, Srikala MD	Nemeth, Alexander J MD	Ormsby, Jacob MBA, MD
Powers, Andria MD	Radhakrishnan, Rupa MBBS, MS	Schoppe, Kurt MD - CSC	Segovis, Colin MD, PhD
Shah, Lubdha M MD	Singhal, Aparna MD

REFERENCES

1. [18321251] Brown DL, Hoffman SN, Jacobs TL, Gruis KL, Johnson SL, Chernew ME. CT angiography is cost-effective for confirmation of internal carotid artery occlusions. J Neuroimaging. 2008 Oct;18(4):355-9.
2. [20609882] Hellinger JC, Pena A, Poon M, Chan FP, Epelman M. Pediatric computed tomographic angiography: imaging the cardiovascular system gently. Radiol Clin North Am. 2010 Mar;48(2):439-67, x.
3. [21979145] Stence NV, Fenton LZ, Goldenberg NA, Armstrong-Wells J, Bernard TJ. Craniocervical arterial dissection in children: diagnosis and treatment. Curr Treat Options Neurol. 2011;13(6):636-648.
4. [18300898] Chen W, Wang J, Xin W, Peng Y, Xu Q. Accuracy of 16-row multislice computed tomographic angiography for assessment of small cerebral aneurysms. Neurosurgery. 2008 Jan;62(1):113-21; discussion 121-2.
5. [15105978] Dammert S, Krings T, Moller-Hartmann W, et al. Detection of intracranial aneurysms with multislice CT: comparison with conventional angiography. Neuroradiology. 2004;46(6):427-434.
6. [14699177] Jayaraman MV, Mayo-Smith WW, Tung GA, et al. Detection of intracranial aneurysms: multi-detector row CT angiography compared with DSA. Radiology. 2004;230(2):510-518.
7. [18065510] McKinney AM, Palmer CS, Truwit CL, Karagulle A, Teksam M. Detection of aneurysms by 64-section multidetector CT angiography in patients acutely suspected of having an intracranial aneurysm and comparison with digital subtraction and 3D rotational angiography. AJNR Am J Neuroradiol. 2008;29(3):594-602.
8. [15502126] Teksam M, McKinney A, Casey S, Asis M, Kieffer S, Truwit CL. Multi-section CT angiography for detection of cerebral aneurysms. AJNR Am J Neuroradiol. 2004 Oct;25(9):1485-92.
9. [24275611] Mehan WA Jr, Romero JM, Hirsch JA, et al. Unruptured intracranial aneurysms conservatively followed with serial CT angiography: could morphology and growth predict rupture?. J Neurointerv Surg. 6(10):761-6, 2014 Dec.
10. [29567291] Wang GX, Gong MF, Wen L, et al. Computed Tomography Angiography Evaluation of Risk Factors for Unstable Intracranial Aneurysms. World Neurosurg. 2018 Jul;115():S1878-8750(18)30561-8.
11. [18073468] Chaudhary SR, Ko N, Dillon WP, et al. Prospective evaluation of multidetector-row CT angiography for the diagnosis of vasospasm following subarachnoid hemorrhage: a comparison with digital subtraction angiography. Cerebrovasc Dis. 2008;25(1-2):144-50.
12. [15486327] Coutts SB, Lev MH, Eliasziw M, et al. ASPECTS on CTA source images versus unenhanced CT: added value in predicting final infarct extent and clinical outcome. Stroke. 2004 Nov;35(11):2472-6.
13. [15304575] Josephson SA, Bryant SO, Mak HK, Johnston SC, Dillon WP, Smith WS. Evaluation of carotid stenosis using CT angiography in the initial evaluation of stroke and TIA. Neurology. 2004 Aug 10;63(3):457-60.
14. [17431875] Tan JC, Dillon WP, Liu S, Adler F, Smith WS, Wintermark M. Systematic comparison of perfusion-CT and CT-angiography in acute stroke patients. Ann Neurol. 2007 Jun;61(6):533-43.
15. [18467521] Torres-Mozqueda F, He J, Yeh IB, et al. An acute ischemic stroke classification instrument that includes CT or MR angiography: the Boston Acute Stroke Imaging Scale. AJNR Am J Neuroradiol. 2008 Jun;29(6):1111-7.
16. [12691409] Wintermark M, Uske A, Chalaron M, et al. Multislice computerized tomography angiography in the evaluation of intracranial aneurysms: a comparison with intraarterial digital subtraction angiography. J Neurosurg. 2003 Apr;98(4):828-36.
17. [17213425] Yoon DY, Lim KJ, Choi CS, Cho BM, Oh SM, Chang SK. Detection and characterization of intracranial aneurysms with 16-channel multidetector row CT angiography: a prospective comparison of volume-rendered images and digital subtraction angiography. AJNR Am J Neuroradiol. 2007 Jan;28(1):60-7.
18. [22343088] Chatzikonstantinou A, Krissak R, Flüchter S, et al. CT angiography of the aorta is superior to transesophageal echocardiography for determining stroke subtypes in patients with cryptogenic ischemic stroke. Cerebrovasc Dis. 2012;33(4):322-8.
19. [20360341] Furtado AD, Adraktas DD, Brasic N, et al. The triple rule-out for acute ischemic stroke: imaging the brain, carotid arteries, aorta, and heart. AJNR Am J Neuroradiol. 2010 Aug;31(7):1290-6.
20. [20884748] Greenberg ED, Gold R, Reichman M, et al. Diagnostic accuracy of CT angiography and CT perfusion for cerebral vasospasm: a meta-analysis. AJNR Am J Neuroradiol. 2010;31(10):1853-1860.
21. [16888376] Ritter MA, Poeplau T, Schaefer A, et al. CT angiography in acute stroke: does it provide additional information on occurrence of infarction and functional outcome after 3 months?. Cerebrovasc Dis. 2006;22(5-6):362-7.
22. [23907247] Wintermark M, Sanelli PC, Albers GW, et al. Imaging recommendations for acute stroke and transient ischemic attack patients: A joint statement by the American Society of Neuroradiology, the American College of Radiology, and the Society of NeuroInterventional Surgery. AJNR Am J Neuroradiol 2013;34:E117-27.
23. [27765736] Sundaram S, Kannoth S, Thomas B, Sarma PS, Sylaja PN. Collateral Assessment by CT Angiography as a Predictor of Outcome in Symptomatic Cervical Internal Carotid Artery Occlusion. AJNR Am J Neuroradiol. 38(1):52-57, 2017 Jan.
24. [26614583] Varadharajan S, Saini J, Acharya UV, Gupta AK. Computed tomography angiography in acute stroke (revisiting the 4Ps of imaging). Am J Emerg Med. 2016 Feb;34(2):S0735-6757(15)00949-3.
25. [18065505] Kim J, Smith A, Hemphill JC, et al. Contrast extravasation on CT predicts mortality in primary intracerebral hemorrhage. AJNR Am J Neuroradiol. 2008 Mar;29(3):520-5.
26. [19132425] Romero JM, Artunduaga M, Forero NP, et al. Accuracy of CT angiography for the diagnosis of vascular abnormalities causing intraparenchymal hemorrhage in young patients. Emerg Radiol. 2009 May;16(3):195-201.
27. [24594897] Chakraborty S, Alhazzaa M, Wasserman JK, et al. Dynamic characterization of the CT angiographic 'spot sign'. PLoS One. 2014;9(3):e90431.
28. [22405630] Demchuk AM, Dowlatshahi D, Rodriguez-Luna D, et al. Prediction of haematoma growth and outcome in patients with intracerebral haemorrhage using the CT-angiography spot sign (PREDICT): a prospective observational study. Lancet Neurol. 2012 Apr;11(4):307-14.
29. [24481974] Rodriguez-Luna D, Dowlatshahi D, Aviv RI, et al. Venous phase of computed tomography angiography increases spot sign detection, but intracerebral hemorrhage expansion is greater in spot signs detected in arterial phase. Stroke. 2014 Mar;45(3):734-9.
30. [16552007] Bartlett ES, Walters TD, Symons SP, Fox AJ. Diagnosing carotid stenosis near-occlusion by using CT angiography. AJNR Am J Neuroradiol. 2006 Mar;27(3):632-7.
31. [15055330] Prokop M, Waaijer A, Kreuzer S. CT angiography ofthe carotid arteries. JBR-BTR. 2004;87(1):23-9.
32. [15090363] Randoux B, Marro B, Marsault C. Carotid Artery Stenosis: Competition between CT Angiography and MR Angiography. AJNR Am J Neuroradiol. 2004 Apr;25(4):663-4; author reply 664.
33. [16418351] Wintermark M, Ko NU, Smith WS, Liu S, Higashida RT, Dillon WP. Vasospasm after subarachnoid hemorrhage: utility of perfusion CT and CT angiography on diagnosis and management. AJNR Am J Neuroradiol. 2006 Jan;27(1):26-34.
34. [17325279] Wintermark M, Meuli R, Browaeys P, et al. Comparison of CT perfusion and angiography and MRI in selecting stroke patients for acute treatment. Neurology. 2007 Feb 27;68(9):694-7.
35. [20813553] Barazangi N, Wintermark M, Lease K, Rao R, Smith W, Josephson SA. Comparison of computed tomography angiography and transesophageal echocardiography for evaluating aortic arch disease. J Stroke Cerebrovasc Dis. 2011;20(5):436-42.
36. [22859283] Magge R, Lau BC, Soares BP, et al. Clinical risk factors and CT imaging features of carotid atherosclerotic plaques as predictors of new incident carotid ischemic stroke: a retrospective cohort study. AJNR Am J Neuroradiol. 2013 Feb;34(2):402-9.
37. [19182087] Romero JM, Babiarz LS, Forero NP, et al. Arterial wall enhancement overlying carotid plaque on CT angiography correlates with symptoms in patients with high grade stenosis. Stroke. 2009 May;40(5):1894-6.
38. [18272562] Wintermark M, Jawadi SS, Rapp JH, et al. High-resolution CT imaging of carotid artery atherosclerotic plaques. AJNR Am J Neuroradiol. 2008;29(5):875-882.
39. [30045262] Sun PP, Feng PY, Wang Q, Shen SS. Angiography with the 256-multislice spiral computed tomography and its application in evaluating atherosclerotic plaque and cerebral ischemia. Medicine (Baltimore). 97(30):e11408, 2018 Jul.
40. [23507061] Schmidt WA. Imaging in vasculitis. Best Pract Res Clin Rheumatol. 2013 Feb;27(1):S1521-6942(13)00003-X.
41. [15284541] Berne JD, Norwood SH, McAuley CE, Villareal DH. Helical computed tomographic angiography: an excellent screening test for blunt cerebrovascular injury. J Trauma. 57(1):11-7; discussion 17-9, 2004 Jul.
42. [18292376] Nguyen-Huynh MN, Wintermark M, English J, et al. How accurate is CT angiography in evaluating intracranial atherosclerotic disease?. Stroke. 2008 Apr;39(4):1184-8.
43. [18585935] van Prehn J, Muhs BE, Pramanik B, et al. Multidimensional characterization of carotid artery stenosis using CT imaging: a comparison with ultrasound grading and peak flow measurement. Eur J Vasc Endovasc Surg. 2008 Sep;36(3):267-72.
44. [18646474] Methodius-Ngwodo WC, Burkett AB, Kochupura PV, Wellons ED, Fuhrman G, Rosenthal D. The role of CT angiography in the diagnosis of blunt traumatic thoracic aortic disruption and unsuspected carotid artery injury. Am Surg. 2008;74(7):580-585; discussion 585-586.
45. [18784210] Langner S, Fleck S, Kirsch M, Petrik M, Hosten N. Whole-body CT trauma imaging with adapted and optimized CT angiography of the craniocervical vessels: do we need an extra screening examination?. AJNR Am J Neuroradiol. 29(10):1902-7, 2008 Nov.
46. [23470509] Roberts DJ, Chaubey VP, Zygun DA, et al. Diagnostic accuracy of computed tomographic angiography for blunt cerebrovascular injury detection in trauma patients: a systematic review and meta-analysis. [Review]. Annals of Surgery. 257(4):621-32, 2013 Apr.
47. [28521330] Tessler RA, Nguyen H, Newton C, Betts J. Pediatric penetrating neck trauma: Hard signs of injury and selective neck exploration. J Trauma Acute Care Surg. 2017 Jun;82(6):989-994.
48. [30036715] Todnem N, Hardigan T, Banerjee C, Alleyne CH. Cephalad Migration of Intradural Bullet from Thoracic Spine to Cervical Spine. World Neurosurg. 2018 Nov;119():S1878-8750(18)31414-1.
49. [30429928] Ugalde IT, Claiborne MK, Cardenas-Turanzas M, Shah MN, Langabeer JR 2nd, Patel R. Risk Factors in Pediatric Blunt Cervical Vascular Injury and Significance of Seatbelt Sign. The Western Journal of Emergency Medicine. 19(6):961-969, 2018 Nov.
50. [32890346] Ibraheem K, Wong S, Smith A, et al. Computed tomography angiography in the "no-zone" approach era for penetrating neck trauma: A systematic review. The Journal of Trauma and Acute Care Surgery. 89(6):1233-1238, 2020 12.
51. [17050515] Leach JL, Fortuna RB, Jones BV, Gaskill-Shipley MF. Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. Radiographics. 2006;26 Suppl 1:S19-41; discussion S42-13.
52. [17290117] Taschner C, Leclerc X, Lucas C, Pruvo J. Computed tomography angiography for the evaluation of carotid artery dissections. Front Neurol Neurosci. 2005;20():119-128.
53. [18635617] Vertinsky AT, Schwartz NE, Fischbein NJ, Rosenberg J, Albers GW, Zaharchuk G. Comparison of multidetector CT angiography and MR imaging of cervical artery dissection. AJNR Am J Neuroradiol. 2008;29(9):1753-1760.
54. [29366361] Singh R, Gupta V, Ahuja C, Kumar A, Mukherjee KK, Khandelwal N. Role of time-resolved-CTA in intracranial arteriovenous malformation evaluation at 128-slice CT in comparison with digital subtraction angiography. Neuroradiol J. 2018 Jun;31(3):235-243.
55. [29417173] Xu S, Ruan S, Liu S, Xu J, Gong R. CTA/V detection of bilateral sigmoid sinus dehiscence and suspected idiopathic intracranial hypertension in unilateral pulsatile tinnitus. Neuroradiology. 60(4):365-372, 2018 Apr.
56. [27137997] Sivaraju L, Mani S, Prabhu K, Daniel RT, Chacko AG. Three-dimensional computed tomography angiographic study of the vertebral artery in patients with congenital craniovertebral junction anomalies. Eur Spine J. 2017 Apr;26(4):1028-1038.
57. [18518726] Chen W, Yang Y, Xing W, Qiu J, Peng Y. Sixteen-row multislice computed tomography angiography in the diagnosis and characterization of intracranial aneurysms: comparison with conventional angiography and intraoperative findings. J Neurosurg. 2008 Jun;108(6):1184-91.
58. [16572652] Dehdashti AR, Binaghi S, Uske A, Regli L. Comparison of multislice computerized tomography angiography and digital subtraction angiography in the postoperative evaluation of patients with clipped aneurysms. J Neurosurg. 2006 Mar;104(3):395-403.
59. [15176555] Katano H, Kato K, Umemura A, Yamada K. Perioperative evaluation of carotid endarterectomy by 3D-CT angiography with refined reconstruction: preliminary experience of CEA without conventional angiography. Br J Neurosurg. 2004 Apr;18(2):138-48.
60. [11473180] Lev MH, Farkas J, Rodriguez VR, et al. CT angiography in the rapid triage of patients with hyperacute stroke to intraarterial thrombolysis: accuracy in the detection of large vessel thrombus. J Comput Assist Tomogr. 2001;25(4):520-8.
61. [9393193] Ozsvath RR, Casey SO, Lustrin ES, Alberico RA, Hassankhani A, Patel M. Cerebral venography: comparison of CT and MR projection venography. AJR Am J Roentgenol 1997;169:1699-707.
62. [17641372] Papke K, Kuhl CK, Fruth M, et al. Intracranial aneurysms: role of multidetector CT angiography in diagnosis and endovascular therapy planning. Radiology. 2007 Aug;244(2):532-40.
63. [18599577] Rosenthal ES, Schwamm LH, Roccatagliata L, et al. Role of recanalization in acute stroke outcome: rationale for a CT angiogram-based "benefit of recanalization" model. AJNR Am J Neuroradiol. 2008 Sep;29(8):1471-5.
64. [10094346] Wetzel SG, Kirsch E, Stock KW, Kolbe M, Kaim A, Radue EW. Cerebral veins: comparative study of CT venography with intraarterial digital subtraction angiography. Ajnr: American Journal of Neuroradiology. 20(2):249-55, 1999 Feb.AJNR Am J Neuroradiol. 20(2):249-55, 1999 Feb.
65. [24534028] Bal S, Bhatia R, Shobha N, et al. Stroke- on- Awakening: Safety of CT-CTA Based Selection for Reperfusion Therapy. Can J Neurol Sci. 41(2):182-6, 2014 Mar.
66. [22474060] Fiebach JB, Al-Rawi Y, Wintermark M, et al. Vascular occlusion enables selecting acute ischemic stroke patients for treatment with desmoteplase. Stroke. 2012 Jun;43(6):1561-6.
67. [24003051] González RG, Furie KL, Goldmacher GV, et al. Good outcome rate of 35% in IV-tPA-treated patients with computed tomography angiography confirmed severe anterior circulation occlusive stroke. Stroke. 2013 Nov;44(11):3109-13.
68. [24371030] Nambiar V, Sohn SI, Almekhlafi MA, et al. CTA collateral status and response to recanalization in patients with acute ischemic stroke. AJNR Am J Neuroradiol. 35(5):884-90, 2014 May.
69. [18703807] Schaefer PW, Yoo AJ, Bell D, et al. CT angiography-source image hypoattenuation predicts clinical outcome in posterior circulation strokes treated with intra-arterial therapy. Stroke. 2008 Nov;39(11):3107-9.
70. [30321677] Storey C, Barry J, Adkins W, Nanda A, Saenz-Cuellar H. A Morphometric Analysis for the Feasibility of Percutaneous Translacerum Access of the Internal Carotid Artery Based on Computed Tomography Angiography. World Neurosurg. 121:e925-e930, 2019 Jan.
71. [25299789] Wada K, Nawashiro H, Ohkawa H, Arimoto H, Takeuchi S, Mori K. Feasibility of the combination of 3D CTA and 2D CT imaging guidance for clipping microsurgery of anterior communicating artery aneurysm. Br J Neurosurg. 2015 Apr;29(2):229-36.
72. [12533343] Goodman DN, Hoh BL, Rabinov JD, Pryor JC. CT angiography before embolization for hemorrhage in head and neck cancer. AJNR Am J Neuroradiol. 2003 Jan;24(1):140-2.
73. [18201613] Kramer M, Vairaktaris E, Nkenke E, Schlegel KA, Neukam FW, Lell M. Vascular mapping of head and neck: computed tomography angiography versus digital subtraction angiography. J Oral Maxillofac Surg. 2008 Feb;66(2):302-7.
74. [15709120] Sims JR, Rordorf G, Smith EE, et al. Arterial occlusion revealed by CT angiography predicts NIH stroke score and acute outcomes after IV tPA treatment. AJNR Am J Neuroradiol. 2005 Feb;26(2):246-51.
75. [28871807] Swieton D, Kaszubowski M, Szyndler A, et al. Visualizing Carotid Bodies With Doppler Ultrasound Versus CT Angiography: Preliminary Study. AJR Am J Roentgenol. 2017 Dec;209(6):1348-1352.
76. [28845691] Xiao Z, Zheng Y, Li J, Chen D, Liu F, Cao D. Four-dimensional CT angiography (4D-CTA) in the evaluation of juvenile nasopharyngeal angiofibromas: comparison with digital subtraction angiography (DSA) and surgical findings. Dentomaxillofac Radiol. 2017 Dec;46(8):20170171.
77. [25480885] Srinivasan VM, Schafer S, Ghali MG, Arthur A, Duckworth EA. Cone-beam CT angiography (Dyna CT) for intraoperative localization of cerebral arteriovenous malformations. J Neurointerv Surg. 8(1):69-74, 2016 Jan.
78. [25828501] Jost GF, Dailey AT. Bow hunter's syndrome revisited: 2 new cases and literature review of 124 cases. Neurosurg Focus 2015;38:E7.
79. [17213444] Chuang WC, Short JH, McKinney AM, Anker L, Knoll B, McKinney ZJ. Reversible left hemispheric ischemia secondary to carotid compression in Eagle syndrome: surgical and CT angiographic correlation. AJNR Am J Neuroradiol. 2007 Jan;28(1):143-5.
80. [26680139] Suarez-Kelly LP, Patel DA, Britt PM, et al. Dead or alive? New confirmatory test using quantitative analysis of computed tomographic angiography. J Trauma Acute Care Surg. 2015 Dec;79(6):995-1003; discussion 1003.
81. [-3120926] American College of Radiology. ACR-SPR Practice Parameter for Imaging Pregnant or Potentially Pregnant Patients with Ionizing Radiation. Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=23+&releaseId=2.
82. [-3197742] American College of Radiology. ACR–SPR Practice Parameter for Performing and Interpreting Diagnostic Computed Tomography (CT). Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=132+&releaseId=2
83. [-3197748] American College of Radiology. ACR–SPR Practice Parameter for the use of Intravascular Contrast Media. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=142+&releaseId=2
84. [19729539] Kim JJ, Dillon WP, Glastonbury CM, Provenzale JM, Wintermark M. Sixty-four-section multidetector CT angiography of carotid arteries: a systematic analysis of image quality and artifacts. AJNR Am J Neuroradiol. 2010 Jan;31(1):91-9.
85. [19461032] Oleinik A, Romero JM, Schwab K, et al. CT angiography for intracerebral hemorrhage does not increase risk of acute nephropathy. Stroke. 40(7):2393-7, 2009 Jul.
86. [20566813] Loftus ML, Minkowitz S, Tsiouris AJ, Min RJ, Sanelli PC. Utilization guidelines for reducing radiation exposure in the evaluation of aneurysmal subarachnoid hemorrhage: A practice quality improvement project. AJR Am J Roentgenol. 2010 Jul;195(1):176-80.
87. [23564712] Siegel MJ, Hildebolt C, Bradley D. Effects of automated kilovoltage selection technology on contrast-enhanced pediatric CT and CT angiography. Radiology. 2013 Aug;268(2):538-47.
88. [24384672] Komlosi P, Zhang Y, Leiva-Salinas C, et al. Adaptive statistical iterative reconstruction reduces patient radiation dose in neuroradiology CT studies. Neuroradiology. 2014 Mar;56(3):187-93.
89. [22517962] Singh S, Kalra MK, Shenoy-Bhangle AS, et al. Radiation dose reduction with hybrid iterative reconstruction for pediatric CT. Radiology. 2012 May;263(2):537-46.
90. [15856243] Lell M, Tomandl BF, Anders K, Baum U, Nkenke E. Computed tomography angiography versus digital subtraction angiography in vascular mapping for planning of microsurgical reconstruction of the mandible. Eur Radiol. 2005 Aug;15(8):1514-20.
91. [37832195] Yuan D, Li L, Zhang Y, et al. Image quality improvement in head and neck CT angiography: Individualized post-trigger delay versus fixed delay. Eur J Radiol. 2023 Nov;168():S0720-048X(23)00456-4.
92. [36862232] Dieckmeyer M, Sollmann N, Kupfer K, et al. Computed Tomography of the Head : A Systematic Review on Acquisition and Reconstruction Techniques to Reduce Radiation Dose. Clin Neuroradiol. 2023 Sep;33(3):591-610.
93. [36606518] Huang X, Zhao W, Wang G, et al. Improving image quality with deep learning image reconstruction in double-low-dose head CT angiography compared with standard dose and adaptive statistical iterative reconstruction. Br J Radiol. 2023 Mar;96(1143):20220625.
94. [17361374] Sparacia G, Bencivinni F, Banco A, Sarno C, Bartolotta TV, Lagalla R. Imaging processing for CT angiography of the cervicocranial arteries: evaluation of reformatting technique. Radiol Med. 2007 Mar;112(2):224-38.
95. [18234230] Wintermark M, Glastonbury C, Tong E, et al. Semi-automated computer assessment of the degree of carotid artery stenosis compares favorably to visual evaluation. J Neurol Sci. 2008 Jun 15;269(1-2):74-9.
96. [16148705] Leong JL, Batra PS, Citardi MJ. Three-dimensional computed tomography angiography of the internal carotid artery for preoperative evaluation of sinonasal lesions and intraoperative surgical navigation. Laryngoscope. 115(9):1618-23, 2005 Sep.
97. [16552008] Bartlett ES, Symons SP, Fox AJ. Correlation of carotid stenosis diameter and cross-sectional areas with CT angiography. AJNR Am J Neuroradiol. 2006 Mar;27(3):638-42.
98. [18653685] Bartlett ES, Walters TD, Symons SP, Aviv RI, Fox AJ. Classification of carotid stenosis by millimeter CT angiography measures: effects of prevalence and gender. AJNR Am J Neuroradiol. 2008 Oct;29(9):1677-83.
99. [16418349] Bartlett ES, Walters TD, Symons SP, Fox AJ. Quantification of carotid stenosis on CT angiography. AJNR Am J Neuroradiol. 2006 Jan;27(1):13-9.
100. [17170356] Bartlett ES, Walters TD, Symons SP, Fox AJ. Carotid stenosis index revisited with direct CT angiography measurement of carotid arteries to quantify carotid stenosis. Stroke. 2007 Feb;38(2):286-91.
101. [17608907] Bucek RA, Puchner S, Haumer M, Reiter M, Minar E, Lammer J. CTA quantification of internal carotid artery stenosis: application of luminal area vs. luminal diameter measurements and assessment of inter-observer variability. J Neuroimaging. 2007 Jul;17(3):219-26.
102. [15516601] Cademartiri F, Nieman K, van der Lugt A, et al. Intravenous contrast material administration at 16-detector row helical CT coronary angiography: test bolus versus bolus-tracking technique. Radiology. 2004 Dec;233(3):817-23.
103. [-3197621] American College of Radiology. ACR Practice Parameter for Communication of Diagnostic Imaging Findings. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=74+&releaseId=2
104. [-3197634] American College of Radiology. ACR–AAPM Technical Standard for Diagnostic Medical Physics Performance Monitoring of Computed Tomography (CT) Equipment. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=131+&releaseId=2
105. [29654560] Zhao L, Li F, Zhang Z, et al. Assessment of an advanced virtual monoenergetic reconstruction technique in cerebral and cervical angiography with third-generation dual-source CT: Feasibility of using low-concentration contrast medium. Eur Radiol. 2018 Oct;28(10):4379-4388.
106. [19585123] Ferda J, Novák M, Mírka H, et al. The assessment of intracranial bleeding with virtual unenhanced imaging by means of dual-energy CT angiography. Eur Radiol. 2009 Oct;19(10):2518-22.
107. [25614477] Jiang XY, Zhang SH, Xie QZ, et al. Evaluation of Virtual Noncontrast Images Obtained from Dual-Energy CTA for Diagnosing Subarachnoid Hemorrhage. AJNR Am J Neuroradiol. 2015 May;36(5):855-60.
108. [28711203] Kamalian S, Lev MH, Pomerantz SR. Dual-Energy Computed Tomography Angiography of the Head and Neck and Related Applications. Neuroimaging Clin N Am. 2017 Aug;27(3):S1052-5149(17)30044-8.
109. [28926370] Symons R, Reich DS, Bagheri M, et al. Photon-Counting Computed Tomography for Vascular Imaging of the Head and Neck: First In Vivo Human Results. Invest Radiol. 2018 Mar;53(3):135-142.
110. [38460543] Madhavan AA, Bathla G, Benson JC, Diehn FE, Nagelschneider AA, Lehman VT. High yield clinical applications for photon counting CT in neurovascular imaging. Br J Radiol. 2024 May 07;97(1157):894-901.