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Imaging Report - MRA Neck, With and Without Contrast

Evaluation for vertebrobasilar insufficiency — no stenosis or dissection, but a technically suboptimal study

Patient
Tyler Bishop
Exam Date
05/08/2025
Date Signed
05/11/2025
Age / Sex
37 / Male
Ordered By
Z. Fellows, MD
Accession
IHS4493580
Imaging Healthcare Specialists
Procedure: MRA Neck W/WO Contrast  |  Comparison: None
Indication: Pressure in neck with exertion, evaluate for vertebrobasilar insufficiency.
Contrast: Gadavist, 10 mL administered (single-use vial 10 mL; none discarded; Lot KT0S755).
Conclusion
1. Suboptimal examination secondary to venous contamination. 2. No significant stenosis or dissection.

Result

No hemodynamically significant stenosis or dissection — bilaterally

All eight vessels assessed (common, internal, external carotid and vertebral arteries, both sides) were free of hemodynamically significant stenosis or dissection.

Vessel-by-Vessel Findings
VesselRightLeft
Common Carotid No stenosis / dissection No stenosis / dissection
Internal Carotid No stenosis / dissection No stenosis / dissection
External Carotid No stenosis / dissection No stenosis / dissection
Vertebral No stenosis / dissection No stenosis / dissection
Findings: Suboptimal examination secondary to venous contamination. Bones: No significant abnormality. Base of Neck: No significant abnormality. Incidentally detected thyroid nodules less than 1 cm in patients less than 35 years of age, and less than 1.5 cm in patients greater than 35 years of age, do not typically require further imaging. Lung Apices: No visualized abnormality. The lungs are not well assessed by MRI. Other: None.
Interpretation and its limit: This study answers the question it was ordered for — there is no large-vessel stenosis or dissection to explain exertional neck pressure, light-headedness, or the query of vertebrobasilar insufficiency.

However, the radiologist flagged the study as "suboptimal secondary to venous contamination." Venous contamination degrades arterial signal on MRA and reduces sensitivity, particularly for subtle or distal disease. A negative result on a suboptimal study is weaker evidence than a negative result on a clean one. If exertional symptoms, light-headedness, or transient loss of consciousness persist, a repeat MRA or a CT angiogram of the head and neck would give a more definitive answer — and dynamic/positional causes and autonomic or cardiac etiologies would remain unaddressed by this study either way.

Patient Details

Bishop, Tyler

DOB: 05/26/1987 | Age 37 | Sex: Male

Patient ID: 30000205475

Providers

Ordering: Zachary Thomas Fellows, MD

6120 Paseo Del Norte, Suite C-1, Carlsbad, CA 92011

Radiologist: Eric Chou, MD

Authenticated 05/11/2025 15:21

Facility

Imaging Healthcare Specialists — Encinitas

477 N. El Camino Real, Suite A-102

Encinitas, CA 92024 | (858) 658-6500

Accession #: IHS4493580