Helical CT angiography in the preoperative evaluation of carotid artery stenosis

Cinat, Marianne; Lane, Christopher T.; Pham, Hanh; Lee, Andrew; Wilson, Samuel E.; Gordon, Ian L.

doi:10.1016/s0741-5214(98)70165-x

Cited by 85 publications

(37 citation statements)

References 31 publications

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“…CT has been found in multiple trials to be accurate in the diagnosis of carotid artery stenosis but can lead to miscategorization of the degree of stenosis, especially if not performed and evaluated properly or if the plaques causing stenosis are heavily calcified [8][9][10][11][12][13]. However, our groups for classification of the percentage luminal stenosis for total vessel and individual vessel scores were relatively broad, making error in categorization less likely.…”

Section: Discussionmentioning

confidence: 94%

“…This may partly be because of the predominant use of sonography and MR angiography in imaging studies involving the neck vasculature, but these techniques are significantly limited in the evaluation of calcium. MDCT angiography is a robust technique for assessing calcification and can potentially depict and allow quantification of load in the carotid arteries in a manner similar to coronary artery scoring, while being highly accurate for measuring luminal stenosis [8][9][10][11][12][13].…”

mentioning

confidence: 99%

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Carotid Artery Calcification on CT May Independently Predict Stroke Risk

Nandalur

Baskurt

Hagspiel

et al. 2006

American Journal of Roentgenology

123

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OBJECTIVE-The purpose of our study was to quantitatively evaluate calcified atherosclerotic burden in the cervical carotid arteries using MDCT to determine the relationship of scores with luminal stenosis and symptomatology.MATERIALS AND METHODS-Calcium plaque volume was measured in 106 cervical carotid arteries (53 patients) using MDCT angiography. The study group included 32 asymptomatic patients (mean age, 70.2 ± 8.7 [SD] years; 15 women, 17 men) and 21 patients with ischemic neurologic symptoms (69.6 ± 12.9 years; eight women, 13 men). By vessel, there were 43 high-grade stenotic (≥ 60% by North American Symptomatic Carotid Endarterectomy Trial [NASCET] criteria), 15 moderate-grade stenotic (30-59%), and 44 mild-grade stenotic or normal (0-29%) vessels, with four excluded for prior carotid endarterectomy. Volume scores were calculated by summing the area of calcium in the common and extracranial internal carotid arteries on axial slices and multiplying by the slice increment.RESULTS-Controlling for cardiovascular risk factors and luminal stenosis, we found that scores were significantly related to the occurrence of symptoms (p = 0.003). Even with patient age as a covariant, patients with high-grade stenosis had significantly higher scores than those without highgrade disease (p = 0.004). Moreover, quantitative burden was associated with luminal stenosis on adjusted multivariate analysis (p = 0.034). The specificity and positive predictive value for highgrade luminal narrowing were notably lower on individual vessel analysis than on total score analysis, likely secondary to variability in vascular remodeling.CONCLUSION-Calcium scores in the cervical carotid arteries may represent an independent marker for luminal stenosis and ischemic symptoms. A prospective longitudinal study examining calcium levels and morbidity may be warranted to examine whether burden has a role in risk stratification. KeywordsCT arteriography; calcium; carotid; stroke Vascular calcium deposits have recently become a major research and public interest secondary to increasing evidence of the relationship of calcium scores with atherosclerotic burden and clinical outcome. The prevailing example involves coronary calcium scores measured on CT, which have been associated with luminal stenosis [1], overall coronary atherosclerotic load

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Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

Carotid Artery Calcification on CT May Independently Predict Stroke Risk

Nandalur

Baskurt

Hagspiel

et al. 2006

American Journal of Roentgenology

123

View full text Add to dashboard Cite

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“…18,22,23 Such imaging has classically been achieved with sonography 5,6,[13][14][15][16][17] and MR imaging. 3,[24][25][26][27][28][29] It is surprising that only a few studies have evaluated carotid wall descriptors with CT, [30][31][32] though CT angiography (CTA) is a well-established technique frequently used to assess carotid stenosis. 30,33,34 Previous studies that explored CTA as a means of imaging atherosclerotic plaques have involved older-generation, single-section CT scanners 31,32,[35][36][37][38][39][40] and have usually focused on 1 single component, such as calcium.…”

mentioning

confidence: 99%

High-Resolution CT Imaging of Carotid Artery Atherosclerotic Plaques

Wintermark¹,

Jawadi²,

Rapp³

et al. 2008

AJNR Am J Neuroradiol

336

251

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BACKGROUND AND PURPOSE:Plaque morphologic features have been suggested as a complement to luminal narrowing measurements for assessing the risk of stroke associated with carotid atherosclerotic disease, giving rise to the concept of "vulnerable plaque." The purpose of this study was to evaluate the ability of multidetector-row CT angiography (CTA) to assess the composition and characteristics of carotid artery atherosclerotic plaques with use of histologic examination as the gold standard.

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“…The excellent soft tissue contrast and high spatial resolution inherent to the axial images allow the direct visualization of the plaque, and CT angiography has been proposed in a number of studies as an effective method for the demonstration of plaque morphology. 10,16,17 In a similar way, the difference in attenuation between contrast within the diseased vessel and the surrounding plaque allows the morphology of the stenosed lumen to be analyzed in transverse section from the axial source data. 10 This information is important because in the case of noncircular lumens, angiographic projections must be obtained in the exact transverse plane of the maximal cross-sectional stenosis to be accurate.…”

Section: Discussionmentioning

confidence: 99%

“…10,16,17 In a similar way, the difference in attenuation between contrast within the diseased vessel and the surrounding plaque allows the morphology of the stenosed lumen to be analyzed in transverse section from the axial source data. 10 This information is important because in the case of noncircular lumens, angiographic projections must be obtained in the exact transverse plane of the maximal cross-sectional stenosis to be accurate. In the case of a noncircular lumen, any projection that is not in this optimal plane is likely to have a degree of inaccuracy introduced.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Cross-Sectional Luminal Morphology in Carotid Atherosclerotic Disease by Use of Spiral CT Angiography

Porsche¹,

Walker²,

Mendelow³

et al. 2001

Stroke

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Background and Purpose-This study sought to determine the frequency of noncircular lumens in patients with significant carotid atherosclerotic disease and to evaluate the effect of noncircular lumens on stenosis measurement derived from angiographic projections. Methods-One hundred consecutive patients presenting with an internal carotid artery stenosis of at least 50% were imaged with spiral CT angiography. The transverse morphology of the diseased lumen was assessed on axial images, and the frequency of noncircular lumens was determined. In these cases, maximum intensity projection angiograms were reconstructed in standardized angiographic planes and in a plane selected according to the luminal obliquity, which was chosen to optimize the angiographic representation of the maximal stenosis. North American Symptomatic Carotid Endarterectomy Trial (NASCET) measurements were calculated from the maximum intensity projection images, and differences between values obtained from standard and optimized projections were recorded. Results-Noncircular lumens were observed in 18 of 100 patients and consisted of elliptical and linear transverse profiles.The transverse orientation of the lumen in these cases ranged from ϩ90°to Ϫ87°relative to the anteroposterior plane. An increase in the calculated NASCET stenosis was demonstrated when measurements were obtained from angiographic reconstructions obtained in the exact plane of the luminal obliquity compared with standard angiographic projections. As a result, the stenosis severity was upgraded from moderate to severe in 2 patients. Conclusions-Noncircular

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Helical CT angiography in the preoperative evaluation of carotid artery stenosis

Cited by 85 publications

References 31 publications

Carotid Artery Calcification on CT May Independently Predict Stroke Risk

Carotid Artery Calcification on CT May Independently Predict Stroke Risk

High-Resolution CT Imaging of Carotid Artery Atherosclerotic Plaques

Evaluation of Cross-Sectional Luminal Morphology in Carotid Atherosclerotic Disease by Use of Spiral CT Angiography

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