Possibilities of Radiological Scan Methods With Post-Processing Image Reconstruction in the Assessment of Atherosclerotic Plaques of the Carotid Arteries

Abstract

The aim. To establish the informativeness of the methods of computed tomography angiography, ultrasound diagnostics and magnetic resonance arteriography without contrast in patients with atherosclerosis of carotid arteries. Materials and methods. During July 2022 - July 2024, 82 male patients were examined on the basis of the Neurological Pathology Diagnostic Center of the KNP "Regional Clinical Hospital of the Ivano-Frankivsk Regional Council". Forty-six of them were included in the study group with clinical signs of atherosclerotic lesions of the carotid arteries. Thirty-six patients with asymptomatic course of the carotid arteries atherosclerosis were chosen as the control group. Patients of both groups were aged 51-79 years, and were homogeneous in terms of concomitant diseases, duration of smoking and lipidogram results. Exclusion criteria from both cohorts were: the presence of arrhythmia, radiation treatment of oncological processes in the projection of the head and neck, diagnosed Alzheimer's disease or Fara's disease, lack of written informed consent to participate in the study, impaired legal capacity of the person, when the written consent cannot be considered truly conscious. CTA was performed using a 160-slice computer tomograph Aquilion Prime Toshiba Scanner TSX-302A (Toshiba) with SUREPlaque software to analyze atherosclerotic plaques and vessels in the Carotid CTA fast scanning mode. MRI of the head and neck with non-contrast MR-arteriography was performed using a 1.5 Tesla Phillips Achieva device using blood flow imaging sequences: s3DI MC (three-dimensional time of flight MR-angiography). Ultrasound of the carotid arteries was performed using the Esaote MyLab9eXP device using B-mode, Doppler mapping and elastography. Atherosclerotic plaques were assessed according to the new imaging-based classification - Carotid Plaque-RADS from 2024. The results. According to the classification of Carotid Plaque-RADS, the following results were obtained according to visualization by ultrasound and CT methods: a combination of plaques of categories from Plaque-RADS 2 to Plaque-RADS 4, considering the types of each category, was detected in patients of both groups. There was no significant difference between the groups in the assessment of the structure of the atherosclerotic plaque (p=0.616). For the study group, the detection of the higher percentage of the stenotic lumen of the vessel was statistically different (median - 68.5% (interquartile range 9.75%)) compared to the control group (median - 60.0% (interquartile range 7.5%)) (p =0.048). A comparison of the degree of stenosis by ultrasound and CTA methods was carried out, where a direct correlation of very high strength according to the Chaddock scale was established (r=0.934 (confidence interval: 0.881 – 0.964), p˂0.001). Atherosclerotic lesions were characterized by indirect signs on MRI, namely: wall filling defects, which most likely correspond to plaques, increased bends of main arteries. Conclusions. Ultrasound diagnostics and reconstructive post-processing capabilities of computed tomography were practically equivalent in assessing the degree of stenosis with high correlation strength (r=0.934) and highly informative images of atherosclerotic masses of carotid arteries, while non-contrast magnetic resonance arteriography allowed to suspect atherosclerotic lesions as an area of ​​a filling defect without detailed tissue structures.