Vascular system

Abstract

While many of the pitfalls encountered when imaging the vascular system are common to other body systems, specific challenges are posed by pulsatility and flow within the venous and arterial tree. A good knowledge of variant anatomy and artifacts is essential to the interpretation of all vascular studies and is of particular importance in the emergency setting where, for example, a confident exclusion of aortic dissection may save the patient from major and potentially life-threatening surgery. The need for appreciation of these variables, in particular the vascular territories, is essential, and important examples include the use of ultrasound imaging and magnetic resonance angiography in the delineation and quantification of carotid disease. Catheter angiography is now less frequently undertaken as a diagnostic modality and, as a result, may be more susceptible to errors related to angiographic technique and technical factors. Evaluation of the venous system presents particular challenges, and all radiologists must be conversant with the potential pitfalls related to imaging in cases of suspected pulmonary embolism. Even when all of these factors are taken into consideration, there is no substitute for experience, and even the best radiologists will, from time to time, be caught out. In cases where there is doubt, it is often necessary to supplement the initial investigation with additional confirmatory studies. The radiologist who undertakes vascular imaging needs to be conversant with all imaging modalities and be ready to question the apparent findings and use alternative imaging techniques, when appropriate.