Head and Neck CTA Report Template: Stroke and Carotid Findings

Head and neck CTA report framework

A head and neck CT angiogram should make its coverage and arterial assessment clear. Review the aortic arch and great-vessel origins, cervical carotid and vertebral arteries, and intracranial circulation only to the extent actually shown and opacified. In acute stroke work-up, describe a large-vessel occlusion, its exact segment, distal reconstitution, and any tandem cervical lesion prominently. CTA is not a substitute for a separately acquired noncontrast head CT or perfusion study.

Use the following as an editable framework. Remove sections that were not acquired, and name any structure that cannot be assessed.

Indication: [Acute focal deficit / suspected stroke / other clinical question]
Comparison: [Date and examination, if available]
Technique: CT angiography of the head and neck following intravenous contrast administration. [Coverage, bolus timing, and reconstructions per local protocol]. [Motion, dental streak, venous contamination, or other limitation, if present.]

Findings:
Aortic arch and great-vessel origins: [Configuration, patency, and relevant stenosis.]
Right carotid system: [Common carotid artery, bifurcation, proximal and distal internal carotid artery, external carotid artery. Describe plaque and stenosis; state the measurement method for a quantified extracranial ICA stenosis.]
Left carotid system: [Same review.]
Vertebral arteries: [Origins, cervical course, dominance if clear, and patency to the vertebrobasilar junction.]
Intracranial circulation: [Intracranial ICAs, anterior and middle cerebral arteries, vertebrobasilar system, and posterior cerebral arteries. State occlusion, stenosis, aneurysm, or other relevant finding and its segment.]
Other included findings: [Only findings within the acquired field.]

Impression:
1. [Most urgent vascular finding, with side and exact segment.]
2. [Other relevant stenosis, dissection, aneurysm, or vascular variant.]
3. [Important limitation, if it changes confidence.]

Critical-result communication: [Finding communicated to recipient by method at time; document per local policy.]

Acquisition and image-quality checks

Before interpreting the vessels, confirm that the scan covers the intended arch-to-vertex territory and that arterial enhancement is adequate. Check the source images as well as multiplanar and maximum-intensity-projection views; MIP images can clarify vessel continuity but may hide calcified plaque or small lesions. Note motion, streak from dental hardware, poor contrast timing, venous contamination, or incomplete coverage. If one segment is not evaluable, state it rather than using a global “no stenosis” or “patent” conclusion.

For acute stroke, use the institution’s established imaging pathway and avoid delaying time-sensitive care for optional post-processing. The joint ASNR/ACR/SNIS statement describes the role of vascular imaging within stroke imaging strategies; the local pathway determines which examinations accompany CTA.

Systematic arterial review

• Arch and origins: Check arch configuration and the brachiocephalic, left common carotid, and left subclavian origins when included.
• Cervical carotids: Follow each common carotid through the bifurcation and internal carotid artery. Describe plaque location and composition when helpful, the narrowest residual lumen, distal reference segment, and any tandem lesion. For a quantified extracranial ICA stenosis, name the method, commonly NASCET, and avoid implying that an estimate is more precise than image quality allows.
• Vertebral arteries: Follow both origins and cervical segments to the vertebrobasilar junction. State side and segment for stenosis, occlusion, dissection, or a clinically relevant variant.
• Intracranial arteries: Review the intracranial ICAs, ACA, MCA, vertebral arteries, basilar artery, and PCAs. For an occlusion, give the named vessel and segment; describe distal reconstitution and collateral filling when visible.
• Impression and communication: Put an acute occlusion or other time-sensitive finding first. Record communication details in the designated field and follow local closed-loop policy.

Worked example: acute occlusion with a tandem carotid lesion

Fictional teaching case. The following findings are invented for education; they do not describe a patient.

Indication: Sudden right-sided weakness and aphasia.
Comparison: Noncontrast head CT obtained immediately before CTA.
Technique: CT angiography of the head and neck after intravenous contrast. Coverage extends from the aortic arch through the vertex. Axial source images and multiplanar and maximum-intensity-projection reconstructions were reviewed. Mild motion at the skull base.

Findings:
The aortic arch and great-vessel origins are patent. Mixed plaque at the left carotid bulb produces approximately 70% narrowing of the proximal left internal carotid artery by NASCET measurement. The right carotid system is patent without hemodynamically significant narrowing. Both vertebral arteries are patent to the basilar artery.
Abrupt occlusion of the left M1 middle cerebral artery is present, with limited distal branch reconstitution. No intracranial aneurysm is identified. Mild motion at the skull base does not obscure the occlusion.

Impression:
1. Acute left M1 middle cerebral artery occlusion.
2. Approximately 70% proximal left internal carotid artery stenosis by NASCET measurement.

Critical-result communication: [Name/service] notified by [method] at [time]; receipt acknowledged per local policy.

The impression leads with the occlusion and states the precise vessel segment. If the study is technically limited at the carotid bulb, replace the numeric estimate with a qualified description and say what prevents reliable measurement. For a dissection, describe the involved segment and visible features such as an intimal flap or tapered narrowing; do not infer a mural hematoma when the CTA does not demonstrate one.

Common wording and scope errors

• Do not call a vessel normal when it is outside the scan range or obscured by artifact.
• Do not report a carotid percentage without naming the method and the reference anatomy. NASCET measurement on CTA/MRA is distinct from ultrasound velocity criteria.
• Do not use extracranial carotid NASCET percentages as the measurement method for intracranial stenosis.
• Do not equate a normal CTA with a normal brain parenchymal examination; report a separately acquired noncontrast CT or perfusion study separately.
• Do not leave an urgent occlusion only in the findings. State side and segment in the impression and document communication.
• Do not call calcified plaque “severe” from blooming alone when the lumen cannot be measured confidently.

For a separate parenchymal review, use the noncontrast head CT reporting checklist. See NASCET and ECST measurement on CTA or MRA for measurement landmarks, and the critical-result communication guide for documentation principles.

References

1. American College of Radiology, American Society of Neuroradiology, and Society for Pediatric Radiology. Practice Parameter for the Performance of Computed Tomography Angiography of the Head and Neck (revised 2025). ACR document (opens in a new tab)
2. Wintermark M, et al. Imaging recommendations for acute stroke and transient ischemic attack patients: a joint statement by ASNR, ACR, and SNIS. AJNR Am J Neuroradiol. 2013;34:E117–E127. doi:10.3174/ajnr.A3690 (opens in a new tab)
3. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325:445–453. doi:10.1056/NEJM199108153250701 (opens in a new tab)

This educational framework does not determine whether a study is adequate or establish a diagnosis. Adapt it to the images, protocol, clinical question, and local communication pathway before signing.