MRA of the neck – pro
MRA uses a magnetic field, radio waves and a computer to create detailed images of neck area; it is an MRI with angiography. Thus, it si best used to evaluate flow in the carotid arteries, the circle of Willis, the anterior, middle or posterior cerebral arteries, the vertebral or basilar arteries. Numerous articles have demonstrated that MRA can image these vessels with a high degree of sensitivity and specificity. There remains much disagreement when it is appropraite to perform MRA. Medicate says: “•MRA is used to evaluate the carotid arteries, the circle of Willis, the anterior, middle or posterior cerebral arteries, the vertebral or basilar arteries or the venous sinuses;
•MRA is performed on patients with conditions of the head and neck for which surgery is anticipated and may be found to be appropriate based on the MRA. These conditions include, but are not limited to, tumor, aneurysms, vascular malformations, vascular occlusion or thrombosis. Within this broad category of disorders, medical necessity is the underlying determinant of the need for an MRA in specific diseases. The medical records should clearly justify and demonstrate the existence of medical necessity; and
•MRA and CA are not expected to be performed on the same patient for diagnostic purposes prior to the application of anticipated therapy. Only one of these tests will be covered routinely unless the physician can demonstrate the medical need to perform both tests.”
Mukherji SK, Wippold FJ II, Cornelius RS, Brunberg JA, Davis PC, De La Paz RL, Dormont D, Gray L, Jordan JE, Nussenbaum B, Seidenwurm DJ, Sloan MA, Turski PA, Zimmerman RD, Coley BD, Expert Panel on Neurologic Imaging. ACR Appropriateness Criteria® neck mass/adenopathy. [online publication]. Reston (VA): American College of Radiology (ACR); 2009. 8 p. [75 references]
National Coverage Determination (NCD) for Magnetic Resonance Imaging (220.2), 2012