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Normal MRA Neck Report Template (Contrast-Enhanced)
Normal neck MRA report template: contrast-enhanced carotid and vertebral artery wording from the aortic arch to the skull base, NASCET stenosis criteria and dissection, with notes on tandem lesions and time-of-flight pitfalls.
EXAMINATION: MR angiogram of the neck with intravenous contrast. CLINICAL HISTORY: [indication, e.g. “Transient ischemic attack”] COMPARISON: None available. TECHNIQUE: Contrast-enhanced 3D MR angiography of the neck from the aortic arch through the skull base after the intravenous administration of [x] mL of [gadolinium-based contrast agent], with maximum-intensity-projection and multiplanar reformats. [Axial fat-saturated T1 images were obtained for dissection.] FINDINGS: Aortic arch: Normal three-vessel branching pattern. No arch stenosis. Brachiocephalic and subclavian arteries: Patent, without stenosis. Common carotid arteries: Patent bilaterally, without stenosis or irregularity. Carotid bifurcations and internal carotid arteries: The carotid bifurcations are at the C3-4 level bilaterally. No hemodynamically significant stenosis of either internal carotid artery by NASCET criteria. No ulcerated plaque. The cervical internal carotid arteries are patent to the skull base, with normal caliber and no dissection flap, intramural hematoma or pseudoaneurysm. External carotid arteries: Patent bilaterally. Vertebral arteries: Patent bilaterally from their origins through the foramen magnum, with normal caliber. [Codominant / right- or left-dominant.] No stenosis, dissection or occlusion. Visualized intracranial vessels: The petrous and cavernous internal carotid segments and the vertebrobasilar junction are patent. Soft tissues: No paravascular mass. The visualized thyroid is unremarkable. IMPRESSION: 1. No hemodynamically significant stenosis, dissection or occlusion of the cervical carotid or vertebral arteries.
Dictation notes
- Quantify every stenosis by NASCET (distal normal ICA as the denominator) and give the percentage range (under 50, 50-69, 70-99, near-occlusion, occluded) — carotid surgery and stenting thresholds are written in that language.
- Dissection is confirmed on the axial fat-saturated T1 (crescentic intramural hematoma), not on the MIP — the MRA alone shows only the luminal narrowing and can miss the diagnosis entirely.
- A near-occlusion with a “string sign” is managed differently from a 70-99% stenosis; say which it is, and add that the distal ICA is collapsed when it is.
- Report tandem lesions — a cervical stenosis with an intracranial stenosis in the same territory — in one impression line; the combination changes the intervention.
- Time-of-flight MRA of the neck overestimates stenosis and mimics occlusion at the bulb from turbulent flow; if the study was non-contrast, the technique should name it and the impression should offer CTA or ultrasound confirmation for any 50%+ call.
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