Identification of vertebral arteries on CT of the chest

Knowledge of the superior mediastinal course of the vertebral arteries is important for radiologists who evaluate chest CT, particularly in the setting of trauma, when planning a percutaneous interventional procedure or for pre-operative planning. Our aim was to determine how often the vertebral arteries could be identified on chest CT studies. Contrast enhanced chest CT studies from 100 consecutive patients were reviewed, with specific attention to the vertebral arteries in the superior mediastinal and thoracic outlet regions. The left vertebral artery was identified in 85 patients and the right vertebral artery in 76 patients. Non-visualization of a vertebral artery was usually owing to proximal venous occlusion with extensive collateral vessels in the expected location of the vertebral arteries, local lymphadenopathy, poor contrast bolus technique or local beam hardening artefact. Radiologists need to alert surgeons planning resection of mass lesions in this region to the location of the vertebral arteries. It is also important to note that a vertebral artery was not identified on chest CT in 24% of patients.