Advanced

AJNR - American Journal of Neuroradiology

This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Saba, L. Articles by Mallarini, G. Search for Related Content PubMed PubMed Citation Articles by Saba, L. Articles by Mallarini, G.

Efficacy and Sensitivity of Axial Scans and Different Reconstruction Methods in the Study of the Ulcerated Carotid Plaque Using Multidetector-Row CT Angiography: Comparison with Surgical Results

L. Saba^a, G. Caddeo^c, R. Sanfilippo^b, R. Montisci^b and G. Mallarini^a,c

^a Department of Imaging Science, Policlinico Universitario, Cagliari, Italy
^b Department of Vascular Surgery, Policlinico Universitario, Cagliari, Italy
^c Institute of Radiology, University of Cagliari, Cagliari, Italy

View larger version (35K): [in this window] [in a new window]   Fig 1. A 71-year-old man with persistent monocular visual loss. VR (A, B), MIP (C), and axial scans (D) show a severe and irregular ulcerated plaque of the internal carotid artery (ICA). In the left ICA, proximal to the point of maximum stenosis (60% NASCET), is clearly depicted an ulceration of 2 mm (red arrows). In the VR images, A is set without contrast media histogram and B is set with contrast media histogram. In C, there is visible hook morphology (ICA, blue arrow).

View larger version (40K): [in this window] [in a new window]   Fig 2. A 65-year-old woman with TIA. Ulcerated plaque of the left internal carotid artery (ICA); the typical button-of-shirt morphology is visible. Axial scan (A) illustrates ulcerations in a mixed plaque and displays a dissectionlike aspect. VR (B, C) clearly depicts the ulceration. Gross anatomic inspection confirms the presence of the ulcer (D). In this patient, the plaque is heavily calcified proximally and is not calcified at the location of the ulcer. This ulcer is distal to the point of maximum stenosis located in the bifurcation (80% NASCET), and could also have been a pseudoaneurysm from carotid dissection, but the surgical specimen confirmed the presence of ulceration. Note the big plaque calcification located in the bulbus/bifurcation (yellow arrows, ulceration; blue arrows, maximum stenosis point; green arrow, ICA; blue arrowhead, calcified plaque). The external carotid artery ostium is not visible because the cut plane passed through it.

View larger version (63K): [in this window] [in a new window]   Fig 3. A 78-year-old man with TIA. Ulcerated plaque of the left CCA. Axial scan (A) shows ulcerations in a calcified plaque; the atheromatous plaque involved the common carotid artery, the carotid bifurcation, and internal carotid artery origin. This ulcer is proximal to the point of maximum stenosis (90% NASCET). The ulceration was easily detected using VR technique with 1 histogram (B) and 2 histograms (C, D). Ulceration was less clearly visible using MIP and MPR reconstruction (E, F). Note: B is an internal visual, where the lumen is cut to clarify the ulcers. (red arrow in axial image and yellow arrows in VR, MIP, and MPR images, ulceration; green arrows, ICA; blue arrows, CCA)

View larger version (9K): [in this window] [in a new window]   Fig 4. Graph shows the sensitivity of SSD, MPR, MIP, VR, axial, and axial + VR. Mean values () and 95% confidence intervals (error bars) are indicated

View larger version (9K): [in this window] [in a new window]   Fig 5. Graph shows the specificity of SSD, MPR, MIP, VR, axial, and axial + VR. Mean values () and 95% confidence intervals (error bars) are indicated

View larger version (16K): [in this window] [in a new window]   Fig 6. Graph shows sensitivity, specificity, PPV, NPV of SSD, MPR, MIP, VR, axial, and axial + VR.