How to diagnose cervical stenosis?

From the Guidelines

Cervical stenosis diagnosis is typically performed using non-invasive imaging modalities such as Duplex carotid ultrasonography, Computed Tomography Angiography (CTA), and Magnetic Resonance Angiography (MRA).

Key Imaging Modalities

• Duplex carotid ultrasonography: might be considered for patients with nonspecific neurological symptoms when cerebral ischemia is a plausible cause 1.
• CTA and MRA: can provide the information needed to guide the choice of medical, endovascular, or surgical treatment in most cases, although they may overestimate the severity of stenosis 1.

Indications for Imaging

• Cervical bruit in an asymptomatic patient
• Follow-up of known stenosis (>50%) in asymptomatic individuals
• Vascular assessment in a patient with multiple risk factors for atherosclerosis
• Stroke risk assessment in a patient with CAD or PAD
• Amaurosis fugax
• Hemispheric TIA
• Stroke in a candidate for carotid revascularization
• Follow-up after a carotid revascularization procedure
• Intraoperative assessment during CEA or stenting 1

Diagnostic Considerations

• Catheter-based angiography may be necessary in some cases for definitive diagnosis or to resolve discordance between non-invasive imaging findings, and is considered the "gold standard" for measuring the degree of stenosis of a cervical or cephalic artery 1.
• The severity of stenosis is defined according to angiographic criteria by the method used in NASCET, but it corresponds as well to assessment by sonography and other accepted methods of measurement such as CTA and MRA 1.

From the Research

Diagnosis of Cervical Stenosis

To diagnose cervical stenosis, several methods can be employed, including:

• Hysteroscopy: a procedure that allows for the visualization of the uterine cavity and cervical canal 2, 3
• Fluoroscopic guidance: can be used to cannulate and dilate the cervix 4
• Ultrasound guidance: can be used to guide procedures such as embryo transfer and hysteroscopy 5, 6
• Manual dilatation: can be used to dilate the cervix and access the uterine cavity 5, 6

Classification of Cervical Stenosis

Cervical stenosis can be classified into different types, including:

• Type I: stenosis of the external cervical ostium (ECO) 2
• Type II: stenosis of the distal third of the cervical channel and the internal cervical ostium (ICO) 2
• Type III: stenosis of the ICO 2
• Type IV: combined stenosis of the ECO and ICO 2

Management of Cervical Stenosis

Management strategies for cervical stenosis include:

• Preprocedural use of cervical-ripening agents or osmotic dilators 5, 6
• Hysteroscopic resection of the obstructed endocervical canal 5, 3
• Use of miniaturized mechanical or bipolar instruments to overcome stenosis 2
• Adhesiolysis with the distal tip of the hysteroscope 2