CT Angiogram of the Neck

A CT angiogram of the neck maps the arteries that carry blood from the chest up to the brain — the carotids on either side of the windpipe and the vertebral arteries running through the neck bones. Dye is injected and the scanner sweeps while it is still in the arteries. It is the test used to find a narrowing, a clot or a torn artery wall.

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What it is

Four arteries carry blood up the neck to the brain, and most strokes that begin outside the skull begin in one of them. This scan is built to show those four vessels along their whole length in the neck. An iodine-based dye is injected into an arm vein, and the scanner is timed to sweep while the dye is filling the arteries rather than after it has passed through. Software then strips away bone and muscle, leaving a model of the vessel tree that can be rotated and measured. It is an image of the pipes, not of the brain tissue they feed — a plain CT or an MRI answers that separate question, and the two are often ordered together.

Why it is done

  • To look for narrowing of a carotid artery in someone who has had a stroke or a transient warning episode, and to measure how tight it is
  • To find a tear in an artery wall after a neck injury or a sudden neck pain with neurological symptoms
  • To trace a blockage from the neck upward when a clot is being considered for removal
  • To plan or follow up treatment of a narrowed vessel, and to look at the vessels feeding a mass in the neck

What to expect

Patients are normally asked not to eat for several hours beforehand and are questioned about iodine allergy, kidney function and certain diabetes medicines. A cannula goes into an arm vein and the dye is delivered rapidly by a pump, which produces a strong warm flush and often a metallic taste that passes within seconds. Lying still with the head straight matters, because the vessel reconstructions depend on each slice lining up. The scanning itself lasts seconds; the appointment lasts much longer than that. A radiologist interprets the images and reports afterwards.

Questions worth asking

  • Carotid ultrasound is often the first test for neck-artery narrowing and costs far less. Was it considered, or already done?
  • Does the quoted price include the contrast, the vessel reconstructions and the radiologist's reading, or just the scan?
  • If a head study is done in the same visit, will I see two separate imaging charges, and is each one in network?
  • If I need repeat surveillance of a known narrowing, how does this scan's price compare with ultrasound follow-up at the same facility?

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