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Grading of Carotid Artery Stenosis in the Presence of Extensive Calcifications: Dual-Energy CT Angiography in Comparison with Contrast-Enhanced MR Angiography

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Abstract

Purpose

We investigated the agreement of dual-energy computed tomography angiography (DE-CTA) and contrast-enhanced magnetic resonance angiography (CE-MRA)in the quantitative measurement of stenoses of the internal carotid artery in comparison with digital subtraction angiography (DSA).

Methods

A total of 21 patients with stenoses of the external carotid artery were investigated with a DE-CTA and CE-MRAbefore undergoing carotid angioplasty. The grade of the stenoses was assessed in axial multiplanar reformations (MPR) before and multi-intensity projections (MIP) after plaque subtraction (PS) and compared with results from CE-MRA and DSA according to the North American Symptomatic Carotid Endarterectomy Trial.

Results

Average grades of stenoses were 80.7 ± 16.1 % (DSA), 81.4 ± 15.3 % (MRA), 80.0 ± 16.7 % (DE-CTA-MPR), and 85.2 ± 14.7 % (DE-CTA-PS-MIP). Of 21 stenoses, 6 were filiform (stenosis grade, 99 %) in the DSA examination. Five of these cases were identified as pseudo-occlusions in MRA, while four were considered as occlusions in DE-CTA-PS-MIP. Another four cases were identified as pseudo-occlusion in DE-CTA-PS-MIP, which were identified as 90 % stenosis in the DSA examination.

Conclusions

In comparison with the gold standard DSA, DE-CTA-MPR had a slightly better agreement in measuring the degree of stenosis of the internal carotid arteries than CE-MRA. In DE-CTA-PS-MIP images, a systematic overestimation has to be taken into account due to partial extinction of the lumen by the PS algorithm. Nevertheless, DE-CTA should be preferred in imaging patients with carotid artery stenosis in the presence of extensive calcifications.

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References

  1. Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N, et al. Heart disease and stroke statistics- 2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117:e25–146.

    Article  PubMed  Google Scholar 

  2. European Carotid Surgery Trialists’ Collaborative Group. MRC European carotid surgery trial: interim results for symptomatic patients with severe (70–99 %) or with mild (0–29 %) carotid stenosis. Lancet. 1991;337:1235–43.

    Article  Google Scholar 

  3. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325:445–53.

    Article  Google Scholar 

  4. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. N Engl J Med. 1998;339:1415–25.

    Article  Google Scholar 

  5. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995;273:1421–8.

    Article  Google Scholar 

  6. Willinsky RA, Taylor SM, TerBrugge K, Farb RI, Tomlinson G, Montanera W. Neurologic complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature. Radiology. 2003;227:522–8.

    Article  PubMed  Google Scholar 

  7. Dawkins AA, Evans AL, Wattam J, Romanowski CA, Connolly DJ, Hodgson TJ, et al. Complications of cerebral angiography: a prospective analysis of 2,924 consecutive procedures. Neuroradiology. 2007;49:753–9.

    Article  CAS  PubMed  Google Scholar 

  8. Cumming MJ, Morrow IM. Carotid artery stenosis: a prospective comparison of CT angiography and conventional angiography. AJR Am J Roentgenol. 1994;163:517–23.

    Article  CAS  Google Scholar 

  9. Koelemay MJ, Nederkoorn PJ, Reitsma JB, Majoie CB. Systematic review of computed tomographic angiography for assessment of carotid artery disease. Stroke. 2004;35:2306–2.

    Article  PubMed  Google Scholar 

  10. Alvarez-Linera J, Benito-León J, Escribano J, Campollo J, Gesto R. Prospective evaluation of carotid artery stenosis: elliptic centric contrast-enhanced MR angiography and spiral CT angiography compared with digital subtraction angiography. AJNR Am J Neuroradiol. 2003;24:1012–9.

    PubMed  Google Scholar 

  11. Chappell FM, Wardlaw JM, Young GR, Gillard JH, Roditi GH, Yip B, et al. Carotid artery stenosis: accuracy of noninvasive tests–individual patient data meta-analysis. Radiology. 2009;251:493–502.

    Article  PubMed  Google Scholar 

  12. Tartari S, Rizzati R, Righi R, Deledda A, Capello K, Soverini R, et al. High-resolution MRI of carotid plaque with a neurovascular coil and contrast-enhanced MR angiography: one-stop shopping for the comprehensive assessment of carotid atherosclerosis. AJR Am J Roentgenol. 2011;196:1164–71.

    Article  Google Scholar 

  13. Romero JM, Babiarz LS, Forero NP, Murphy EK, Schaefer PW, Gonzalez RG, et al. Arterial wall enhancement overlying carotid plaque on CT angiography correlates with symptoms in patients with high grade stenosis. Stroke. 2009;40:1894–6.

    Article  PubMed  Google Scholar 

  14. McKinney AM, Casey SO, Teksam M, Lucato LT, Smith M, Truwit CL, et al. Carotid bifurcation calcium and correlation with percent stenosis of the internal carotid artery on CT angiography. Neuroradiology. 2005;47:1–9.

    Article  PubMed  Google Scholar 

  15. Kwee RM. Systematic review on the association between calcification in carotid plaques and clinical ischemic symptoms. J Vasc Surg. 2010;51:1015–25.

    Article  PubMed  Google Scholar 

  16. Marks MP, Napel S, Jordan JE, Enzmann DR. Diagnosis of carotid artery disease: preliminary experience with maximum-intensity-projectionspiral CT angiography. AJR Am J Roentgenol. 1993;160:1267–71.

    Article  CAS  Google Scholar 

  17. Johnson TR, Krauss B, Sedlmair M, Grasruck M, Bruder H, Morhard D, et al. Material differentiation by dual energy CT: initial experience. Eur Radiol. 2007;17:1510–7.

    Article  PubMed  Google Scholar 

  18. Flohr TG, McCollough CH, Bruder H, Petersilka M, Gruber K, Süss C, et al. First performance evaluation of a dual-source CT (DSCT) system. Eur Radiol. 2006;16:256–68.

    Article  PubMed  Google Scholar 

  19. Brockmann C, Scharf J, Nölte IS, Seiz M, Groden C, Brockmann MA. Dual-energy CT after peri-interventional subarachnoid haemorrhage: a feasibility study. Clin Neuroradiol. 2010;20:231–5.

    Article  CAS  PubMed  Google Scholar 

  20. Uotani K, Watanabe Y, Higashi M, Nakazawa T, Kono AK, Hori Y, et al. Dual-energy CT head bone and hard plaque removal for quantification of calcified carotid stenosis: utility and comparison with digital subtraction angiography. Eur Radiol. 2009;19:2060–5.

    Article  PubMed  Google Scholar 

  21. Thomas C, Korn A, Ketelsen D, Danz S, Tsifikas I, Claussen CD, et al. Automatic lumen segmentation in calcified plaques: dual-energy CT versus standard reconstructions in comparison with digital subtraction angiography. AJR Am J Roentgenol. 2010;194:1590–5.

    Article  Google Scholar 

  22. Korn A, Bender B, Thomas C, Danz S, Fenchel M, Nägele T, et al. Dual energy CTA of the carotid bifurcation: advantage of plaque subtraction for assessment of grade of the stenosis and morphology. Eur J Radiol. 2011;80:e120–5.

    Article  CAS  PubMed  Google Scholar 

  23. Behrendt FF, Schmidt B, Plumhans C, Keil S, Woodruff SG, Ackermann D, et al. Image fusion in dual energy computed tomography: effect on contrast enhancement, signal-to-noise ratio and image quality in computed tomography angiography. Invest Radiol. 2009;44:1–6.

    Article  PubMed  Google Scholar 

  24. Cohen J. Weighted kappa: Nominal scale agreement provision for scaled disagreement or partial credit. Psychological Bull. 1968;70(4):213–20.

    Article  Google Scholar 

  25. Brenner H, Kliebsch U. Dependence of weighted kappa coefficients on the number of categories. Epidemiology. 1996;7:199–202.

    Article  CAS  PubMed  Google Scholar 

  26. Puppini G, Furlan F, Cirota N, Veraldi G, Piubello Q, Montemezzi S, et al. Characterization of carotid atherosclerotic plaque: comparison between magnetic resonance imaging and histology. Radiol Med. 2006;111:921–30.

    Article  CAS  PubMed  Google Scholar 

  27. Kopps A, Ittrich H, Petri S. Multicontrast-weighted magnetic resonance imaging of atherosclerotic plaques at 3.0 and 1.5 T: ex vivo comparison with histopathologic correlation. Eur Radiol. 2007;17:279–86.

    Article  Google Scholar 

  28. Das M, Braunschweig T, Mühlenbruch G, Mahnken AH, Krings T, Langer S, et al. Carotid plaque analysis: comparison of dual-source computed tomography (CT) findings and histopathological correlation. Eur J Vasc Endovasc Surg. 2009;38:14–9.

    Article  CAS  PubMed  Google Scholar 

  29. Nandalur KR, Baskurt E, Hagspiel KD, Phillips CD, Kramer CM. Calcified carotid atherosclerotic plaque is associated less with ischemic symptoms than is noncalcified plaque on MDCT. AJR Am J Roentgenol. 2005;184:295–8.

    Article  Google Scholar 

  30. Nederkoorn PJ, van der Graaf Y, Hunink MGM. Duplex ultrasound and magnetic resonance angiography compared with digital subtraction angiography in carotid artery stenosis. Stroke. 2003;34(5):1324–32.

    Article  PubMed  Google Scholar 

  31. Petersilka M, Bruder H, Krauss B, Stierstorfer K, Flohr TG. Technical principles of dual source CT. Eur J Radiol. 2008;68:362–8.

    Article  PubMed  Google Scholar 

  32. Elgersma OEH, Buijs PC, Wust AFJ, van der Graaf Y, Eikelboom BC, Mali WP. Maximum internal carotid arterial stenosis: assessment with rotational angiography versus conventional intraarterial digital subtraction angiography. Radiology. 1999;213:777–83.

    Article  CAS  PubMed  Google Scholar 

  33. Silvennoinen HM, Ikonen S, Soinne L, Railo M, Valanne L. CT angiographic analysis of carotid artery stenosis: comparison of manual assessment, semiautomatic vessel analysis, and digital subtraction angiography. AJNR Am J Neuroradiol. 2007;28:97–103.

    CAS  PubMed  Google Scholar 

  34. Watanabe Y, Nagayama M. MR plaque imaging of the carotid artery. Neuroradiology. 2010;52:253–74.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany

    A. Korn MD, B. Bender MD, T.-K. Hauser MD, S. Danz MD & U. Ernemann MD

  2. Department of Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany

    H. Brodoefel MD & C. Thomas MD

Authors
  1. A. Korn MD
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  2. B. Bender MD
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  3. H. Brodoefel MD
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  4. T.-K. Hauser MD
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  5. S. Danz MD
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  6. U. Ernemann MD
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  7. C. Thomas MD
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Correspondence to B. Bender MD.

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Korn, A., Bender, B., Brodoefel, H. et al. Grading of Carotid Artery Stenosis in the Presence of Extensive Calcifications: Dual-Energy CT Angiography in Comparison with Contrast-Enhanced MR Angiography. Clin Neuroradiol 25, 33–40 (2015). https://doi.org/10.1007/s00062-013-0276-0

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  • DOI: https://doi.org/10.1007/s00062-013-0276-0

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