Computed tomography and magnetic resonance angiography in cervicocranial vascular disease

Although catheter angiography, or digital subtraction angiography (DSA), is still regarded as the gold standard for imaging of cervicocranial vascular disease, its morbidity, cost, and time-consuming features have prompted the development of noninvasive techniques based on computed tomography (CT) and magnetic resonance imaging. With the advent of powerful software, CT and magnetic resonance angiography are complementing and, in some cases, even replacing DSA in the diagnostic evaluation of carotid atherostenosis, unruptured aneurysms, dissections, stroke, penetrating trauma to the neck, and dural venous sinus occlusive disease. They offer advantages over DSA not only in reduced morbidity and time-saving but also in assessment of brain parenchyma, quantitative perfusion, and abnormalities of vessel walls. In the evaluation of blunt neck injuries and intracranial vascular malformations, fistulas, and vasculitis, CT and magnetic resonance angiography still do not provide as much information as DSA.