There is no way to detect vertebral artery carotid disease with a radiograph. Vertebral artery carotid disease can only be detected by arterial angiography of the carotid arteries, and there is no way to detect it with other radiographic tests, such as X-rays, CTs, or MRIs. Arterial angiography involves injecting a dose of contrast medium into the arteries so that the arterial blood flow can be imaged to show the rate of blood flow in the vertebral arteries and the presence of stenosis and other lesions. There is no way to detect this on imaging alone; only arterial angiography can detect it.