Major radiological outcomes of CTA head and neck performed for dizziness in a major academic Emergency Department. Issue 3 (June 2023)

• Record Type: Journal Article
• Authors: Du, Elizabeth HY; Tenenbaum, Mary N; Bhadelia, Rafeeque A; Sotman, Timothy E; Edlow, Jonathan A; Selim, Magdy H; Chang, Yu-Ming
• Is Part Of: Neuroradiology journal. Volume 36:Issue 3(2023)
• Page Start: 259
• Page End: 266
• Publication Date: 2023-06
• Subjects: Dizziness -- vertigo -- CT angiogram -- posterior circulation stroke -- emergency department; Nervous system -- Radiography -- Periodicals; Neuroradiography -- Periodicals; Electronic journals; 616.804757
• DOI: 10.1177/19714009221124304
• Languages: English
• ISSNs: 1971-4009

Abstract

Purpose: Routine head and neck CTAs (CTAhead+neck ) performed for dizziness in the Emergency Department (ED) has steadily increased, but its clinical utility is still poorly elucidated. Our purpose was to assess the radiologic outcomes of CTAhead+neck in ED dizziness patients. Methods: ED dizziness patients with CTAhead+neck from January 2010 through November 2019 were retrospectively identified and further stratified into central vertigo (CV), peripheral vertigo (PV), and non-specific dizziness (NSD) groups by final clinical diagnoses. Findings on CTAhead+neck (vessel stenosis >50%, occlusion, dissection, and infarct), and infarct on subsequent MRI if performed, were assessed. Differences in imaging findings were analyzed using chi-square or Fisher's exact tests. Results: Of 867 dizziness patients, 88 were diagnosed with CV, 383 with PV, and 396 with NSD. On CTAhead+neck, 11.4% of all patients had posterior CTA findings, including posterior occlusions (4.2%), dissections (1.2%), and infarcts (2.3%). CV patients had more posterior circulation findings (31.8%) versus PV (9.9%) and NSD (8.3%) patients (both p < 0.01). 21.6% of CV patients had acute infarcts on CT versus none for PV and 0.03% for NSD patients (both p < 0.01). On MRI, 46.6% of CV patients had acute posterior circulation infarcts versus none for PV and 0.3% for NSD patients ( p < 0.01). Conclusion: Diagnostic yield for CTAhead+neck for dizziness patients is low except in central vertigo patients which constitute only 1/10th of CTAs performed. Our single institution results support that CTAhead+neck is likely low-yield in patients with high clinical suspicion for PV or NSD and further studies are needed to test this hypothesis.