Carotid Artery Stenosis: Prospective Comparison of CT, Three-dimensional Gadolinium-enhanced MR, and Conventional Angiography

TLDR

The study prospectively compared gadolinium‑enhanced MR angiography and CT angiography with digital subtraction angiography for detecting carotid bifurcation stenosis and plaque morphology. Forty‑four carotid arteries in 22 patients were imaged by CT angiography, enhanced MR angiography, and DSA, with CT and MR scans reconstructed using maximum intensity projection and multiplanar volume reconstruction to assess stenosis degree, length, luminal surface, and ulceration. CT and enhanced MR angiography showed strong correlation with DSA for stenosis degree and length, accurately identified severe stenoses (CT 100%/100% sensitivity/specificity, MR 93%/100%), underestimated stenosis in two cases, detected more ulceration and surface irregularities than DSA, and overall proved adequate for evaluating carotid stenosis.

Abstract

To prospectively compare gadolinium-enhanced magnetic resonance (MR) angiography and computed tomographic (CT) angiography with digital subtraction angiography (DSA) for use in detecting atheromatous stenosis and plaque morphology at the carotid bifurcation.Forty-four carotid arteries (in 22 patients) were analyzed by using CT angiography, enhanced MR angiography, and DSA. CT and enhanced MR angiograms were reconstructed with maximum intensity projection and multiplanar volume reconstruction. The following four features were analyzed: degree of stenosis on the basis of North American Symptomatic Carotid Endarterectomy Trial criteria, length of stenosis, luminal surface, and presence of ulcers.There was significant correlation between CT angiography, enhanced MR angiography, and DSA for degree and length of stenosis. With enhanced MR angiography and CT angiography, degree of stenosis was underestimated in two of 44 cases. No case of overestimation with CT angiography was found. Severe internal carotid artery stenoses were detected with high sensitivity and specificity: 100% and 100%, respectively, with CT angiography; 93% and 100%, respectively, with enhanced MR angiography. Luminal surface irregularities were most frequently seen at CT angiography. With CT angiography and enhanced MR angiography, more ulceration was detected than with DSA.There was a significant correlation between CT angiography, enhanced MR angiography, and DSA in evaluation of carotid artery stenosis. Enhanced MR angiography or CT angiography can be used to adequately evaluate carotid stenosis.