颈动脉斑块性短暂性脑缺血发作的64排CT血管造影评价

目的 探讨64排CT血管造影诊断颈动脉性短暂性脑缺血发作(TIA)的价值及临床应用.方法 对60例TIA患者进行头颈部64排CT血管造影检查,采用血管减影成像技术,对比剂总量60～70 ml,注射流率4.5～5 ml/s;重建方法包括多层面重建(MPR)、最大密度投影(MIP)、容积再现(VR)、曲面重建(CPR)及血管CT仿真内镜(CTVE)重建.15例行数字减影血管造影(DSA)检查, 49行颈动脉超声(US)检查,2例行脑CT灌注成像(CTPI).结果 60例TIA患者中35例(58.3%)可见血管狭窄,其中轻度狭窄26处、中度狭窄8处、重度狭窄4处,血管闭塞3处.共发现斑块49块,其中钙化斑块21块,脂质斑块16块及混合斑块12块.斑块位于颈总动脉13块,动脉分叉22块,颈内动脉14块.30例狭窄患者与超声检查结果相比,对颈动脉狭窄程度判定一致的有26例.15例患者与DSA对照,CTA的敏感性为94.7%,特异性90.9%,准确性93.3%.结论 64排CT血管造影在评价颈动脉狭窄及粥样硬化斑块方面具有重要价值.     

MR和CT血管造影在诊断颈动脉狭窄及内膜切除术后随访中的价值

目的 探讨磁共振血管造影（MRA）、CT血管造影（CTA）在诊断颈动脉狭窄及内膜切除术后随访中的价值。方法 11例22支颈动脉行MRA、CTA、CT仿真内窥镜（CTVE）、多普勒超声（DUS）检查。12支结果与DSA对照。3支颈动脉重度狭窄者行内膜切除术,MRA采用二维、三维时间飞越法。CTA经最大强度投影（MIP）及遮盖表现显示法（SSD）三维重建。应用导航功能行CTVE成像。结果 颈动脉轻度狭窄8支,中度狭窄3支,重度狭窄5支,闭塞1支,5支正常。12支颈动脉与DSA对照：CTA评估血管狭窄与DSA相符者11支,MRA与DSA相符者9支,DUS与DSA相符者7支。CTA、CTVE显示斑块、壁血栓6支,3支手术证实。术后MRA示狭窄解除,CTA示斑块消失。结论 MRA、DUS可用于颈动脉狭窄的筛选及术后随访。CTA评估血管狭窄程度与DSA、手术比较有较好的一致性,并能直接显示钙化斑块。     

螺旋CT血管造影及CT仿真内窥镜诊断颈动脉狭窄

目的评价CT血管造影(CTA)、CT仿真内窥镜(CTVE)诊断颈动脉狭窄的价值.材料与方法9例18支颈动脉行CTA、CTVE、MRA、DUS检查,3例颈动脉重度狭窄者行颈动脉内膜切除术.CTA螺旋CT扫描,层厚3mm,螺距1.0.最大密度投影(MIP)及遮盖表面显示法(SSD)3D血管重建.CIVE导航系统行颈动脉C1VE成像.结果颈动脉轻度狭窄6支,中度狭窄3支,重度狭窄4支,5支正常.显示斑块、附壁血栓13支.8支颈动脉与DSA对照7支相符.3例手术所见与CTA对比一致性较好,术后狭窄解除,斑块消失.结论CTA能准确评估血管狭窄程度,显示斑块.CIVE能观察狭窄管腔内部形态及斑块.     

缺血性脑血管病颈动脉狭窄的影像诊断

目的　评价颈动脉狭窄无创性影像学检查方法的临床应用价值,探讨颈动脉狭窄与缺血性脑血管病之间的联系。　材料与方法　对15例30支颈动脉行多普勒超声（DUS）、磁共振血管造影（MRA）及头部CT&MRI检查。其中5例同时行颈动脉CT血管造影（CTA）,4例与DSA对照,6例颈动脉重度狭窄者行颈动脉内膜切除术。　结果　15例30支颈动脉轻度狭窄（<30%）8支,中度狭窄(30%～69%)6支,重度狭窄(70%～99%)8支(均为一侧),闭塞2支,未见狭窄6支。8支颈动脉重度狭窄者狭窄侧腔隙性脑梗死5例,狭窄对侧皮层梗死1例,双侧脑梗死1例,未见异常1例。颈动脉闭塞侧大脑中动脉分布区脑梗死2例。CTA显示硬化斑块3例。　结论　颈动脉狭窄与脑梗死的发生、发展密切相关。DUS、MRA、CTA结合使用能够在颈动脉狭窄的筛选、诊断、监测中发挥重要作用。     

缺血性脑血管病颈动脉狭窄15例影像诊断

目的　评价颈动脉狭窄无创性影像学检查方法的临床应用价值 ,探讨颈动脉狭窄与缺血性脑血管病之间的联系。材料与方法　对 15例 3 0支颈动脉行多普勒超声 (DUS)、磁共振血管造影 (MRA)及头部CT、MRI检查。其中 5例同时行颈动脉CT血管造影 (CTA) ,4例与DSA对照 ,6例颈动脉重度狭窄者行颈动脉内膜切除术。结果　 15例 3 0支颈动脉 ,轻度狭窄 ( <3 0 % ) 8支 ,中度狭窄 ( 3 0 %～ 69% ) 6支 ,重度狭窄 ( 70 %～ 99% ) 8支 (均为一侧 ) ,闭塞 2支 ,未见狭窄 6支。 8支颈动脉重度狭窄者狭窄侧腔隙性脑梗死 5例 ,狭窄对侧皮层梗死 1例 ,双侧脑梗死 1例 ,未见异常 1例。颈动脉闭塞侧大脑中动脉分布区脑梗死 2例。CTA显示硬化斑块 3例。结论　颈动脉狭窄与脑梗死的发生、发展密切相关。DUS、MRA、CTA结合使用能够在颈动脉狭窄的筛选、诊断、监测中发挥重要作用。     

CTA在头颈部血管疾病诊断中的应用

目的:将CTA与DSA诊断结果进行对比分析,评价CTA对头颈部动脉血管病变的诊断价值。方法:对56例有临床症状的患者行头颈部CTA检查,并在1周之内行DSA检查,将检查结果与CTA进行对照。结果:共检测了56例患者的颈总动脉,颈内外动脉,大脑前、中、后动脉,椎动脉及基底动脉。本组CTA检测出血管壁软斑块32处,软斑块合并钙化斑块24处,单纯钙化斑块46处;血管轻度狭窄124处,中度狭窄86处,重度狭窄43处,血管闭塞9条。结论:CTA作为一种无创性检查方法对头颈部动脉血管的斑块、狭窄及畸形有重要诊断价值,可作为头颈部动脉血管性病变的首选和重要检查方法。     

MRI与DSA对颈动脉狭窄和粥样硬化斑块评估能力的比较

目的 探讨MRI与DSA对颈动脉粥样硬化患者血管狭窄及粥样硬化斑块病变特点评估能力的差异.方法 46例缺血性脑血管疾病患者,超声发现颈动脉粥样硬化斑块后分别行颈动脉MRI及DSA检查.颈动脉MR检查序列包括三维时间飞跃法(3D TOF)、T1WI、T2WI、质子密度加权成像( PDWI)及增强T1WI;颈动脉DSA检查分别摄取颈动脉的正位像和侧位像.观察颈动脉分叉处管腔的狭窄程度和斑块的病变特征,包括纤维帽的状况、斑块内出血和钙化.计算Kappa值分析MRI和DSA对血管狭窄程度判断结果的一致性;应用配对卡方检验检测两种方法对溃疡斑块的检出差异.结果 89支血管的MR图像质量均满足诊断要求.MRI显示血管狭窄程度的M(范围)为50％(16％～78％),DSA显示为47％(7％～73％),二者具有很好的一致性(Kappa值为0.882,P＜0.01).MRI发现34支血管具有斑块纤维帽破溃,DSA发现10支血管具有溃疡斑块(x2=20.346,P＜0.01).此外,MRI发现37支血管有斑块内出血,71支血管有斑块内钙化,而DSA均不能显示.结论 MRI可以准确判断颈动脉的狭窄程度,在显示溃疡斑块、斑块内出血以及钙化方面较DSA更具优势.     

颈动脉斑块彩色多普勒超声联合头颈部CTA诊断缺血性脑卒中患者颈动脉狭窄临床价值

目的 探讨颈动脉斑块彩色多普勒超声(CDFI)联合头颈部CTA在缺血性脑卒中(IS)颈动脉狭窄检查中的临床价值。方法 选取80例IS患者，以DSA检查并根据血管狭窄程度分为轻度组25例、中度组30例和重度组25例，采用CDFI联合头颈部CTA对3组患者进行检查，观察各组斑块长度、斑块厚度以及斑块数量，并对斑块总面积、颈动脉内膜中层厚度(IMT)以及颈总动脉指数(CCA)、颈内动脉指数(ICA)、椎动脉指数(VA)进行比较。结果 经DSA检查显示共有102条狭窄血管，超声检查检出81条狭窄血管，CTA检出狭窄血管90条，超声检查联合CTA检出98条狭窄血管，中度组与重度组斑块总面积、IMT、斑块长度、斑块厚度、斑块数量、CCA、ICA、VA均高于轻度组，且重度组均高于中度组，差异具有统计学意义(P<0.05),颈动脉斑块CDFI与头颈部CTA联合检测的灵敏度、特异度以及准确率均高于单一检测，差异具有统计学意义(P<0.05)。结论 颈动脉斑块CDFI联合头颈部CTA对检查缺血性脑卒中患者颈动脉狭窄具有较高应用价值。     

64层螺旋CT血管造影及超声造影评价颈动脉斑块

目的 探讨64层螺旋CT血管造影(MSCTA)及超声造影(CEUS)在评价颈动脉斑块中的价值.资料与方法 37例颈动脉斑块狭窄患者于1周内分别行MSCTA及CEUS检查,分析颈动脉内中膜厚度/颈动脉管壁厚度、狭窄比率、斑块表面形态,采用CEUS观察斑块内新生血管情况,将斑块分为内中膜增厚型、稳定型及易损斑块.结果 37例共51处病变血管,MSCTA:颈动脉管壁增厚9处;斑块42处,其中稳定斑块27处,易损斑块15处.CEUS:颈动脉内中膜增厚11处;斑块40处,其中稳定斑块23处,易损斑块17处.MSCTA:轻度狭窄21处,中度狭窄15处,重度狭窄12处,闭塞3处;CEUS:轻度狭窄20处,中度狭窄16处,重度狭窄13处,闭塞2处.MSCTA与CEUS对颈动脉斑块狭窄(Kappa=0.71,P＜ 0.05)及斑块稳定性(Kappa=0.69,P＜0.05)评价一致性较好.结论 MSCTA与CEUS对评价颈动脉斑块狭窄及斑块稳定性具有较好的一致性.     

3D TRICKS MRA对颈动脉粥样硬化狭窄的诊断价值

目的：探讨3D TRICKS MRA对颈动脉粥样硬化狭窄的诊断价值。方法：对43例临床疑诊颈动脉粥样硬化狭窄的患者行2D TOF MRA和3D TRICKS MRA检查,其中31例同期行DSA检查,以颈总动脉法（CC法）计算狭窄率。结果：颈动脉闭塞2支,重度狭窄10支,中度狭窄31支,轻度狭窄25支,正常18支。2D TOF MRA、3D TRICKS MRA与DSA对照,显示狭窄部位均与DSA所示相符。2D TOF MRA高估狭窄程度6支,3D TRICKS MRA高估狭窄程度1支。以DSA为标准,2D TOF MRA诊断颈动脉狭窄的敏感度、特异度、诊断符合率分别为91.6%,85.7%,90.3%（K=0.737）;3D TRICKS MRA诊断颈动脉狭窄的敏感度、特异度、诊断符合率分别为97.9%,100%,98.4%（K=0.955）。两种方法对诊断颈动脉狭窄的敏感度、特异度和诊断符合率差异均具有统计学意义（P〈0.05）。结论：3D TRICKS MRA与DSA对评估颈动脉粥样硬化狭窄具有极好的一致性（K=0.955）,明显优于2D TOF MRA（K=0.737,P〈0.05）,是对颈动脉粥样硬化狭窄筛查、术前评估、术后随访的最佳检查方法,能基本替代DSA检查。     

磁共振新技术在颈动脉狭窄诊断中的应用

目的研究增强磁共振血管成像（CE—MRA）技术的成像影响因素,评价MR扫描序列对颈动脉狭窄硬化斑块的应用价值,探讨颈动脉狭窄血流动力学变化与临床症状的联系。方法颈动脉狭窄34例,男22例,女12例。年龄36～78岁,平均56岁。病人首先经多普勒超声（DUS）检查,然后行MRA及CE-MRA。22例同时采用亮血（Bright—blood）、黑血（Black—blood）技术、3例行血流测量分析（Flow measurements）。10例于磁共振检查后1周内接受颈动脉狭窄内膜剥除术。扫描技术：（1）MRA及CE-MRA：MRA：二维时间飞跃法MRA（2D TOF MRA）;CE-MRA：快速梯度回波扫描技术,冠状位采集。最佳扫描延迟时间主要采用造影剂团注试验（test-bolus）法。3例采用时间分辨回波分享血管成像技术（TRATE）。（2）斑块检查序列：亮血与黑血技术及增强前后T1序列。（3）血流测量分析：横断位心电门控2D相位对比序列,Argus系统分析血流方向、流速。结果血管覆盖范围：34例CE-MRA,23例良好显示颈部血管起始段至入颅段。2D TOF法11例。动脉狭窄评估程度：10例手术患者中,CE-MRA正确诊断血管狭窄者9例,低估狭窄程度1例。2D TOF正确诊断血管狭窄程度6例,高估3例,低估1例。22例亮血、黑血技术结合CE—MRA清晰显示血管壁及动脉硬化斑块。颈动脉单独成像24例中,Test—bolus法团注造影剂最佳扫描延迟时间为峰值时间-1s,且监视层面定于主动脉弓者18例。4例眩晕患者,颈动脉狭窄侧后交通动脉（PCOA）显示2例;PCOA粗大1例。狭窄侧未显示PCOA,同侧大脑后动脉主干增粗1例。2例锁骨下动脉窃血综合征血流方向异常,1例无名静脉狭窄,同侧颈静脉血流方向异常。结论（1）CE—MRA能完整、全程显示颈部血管,准确诊断颈动脉、椎动脉狭窄。（2）Test-bolus法确定扫描延迟时间为峰值时间-1s,并将监视层面定于主动脉弓时,可保证造影剂在动脉内达到高峰浓度时采集K空间数据,获得颈动脉单独成像的最佳图像。（3）亮血、黑血技术结合CE-MRA有助于显示颈动脉狭窄硬化斑块。（4）分析、测量颈动脉狭窄的血流动力学变化能全面评价狭窄后血流改变与临床症状的联系。     

Evaluation of the early enhancement of coronary atherosclerotic plaque by contrast-enhanced MR angiography

Purpose

To evaluate the early enhancement of coronary atherosclerotic plaque using contrast-enhanced MR angiography (CE-MRA) and investigate the association between unstable angina pectoris (UAP) and early enhancement of the plaque.

Methods

Forty-one patients presenting with angina pectoris and demonstrating single-vessel disease with non-calcified plaque and significant coronary stenosis (≥50%) on CTA were consecutively recruited for coronary CE-MRA. Contrast-to-noise ratio of the culprit plaque guided by CTA was measured on a cross-sectional multi-planar reconstruction image of the plaque on both pre- and post-CE-MRA. A 50% increasing of CNR was defined as plaque enhancement. The association between early enhancement of the plaques and UAP was analyzed.

Results

Thirty-seven non-calcified plaques with significant coronary stenosis were detected in the 37 patients on MRA. 4 subjects were excluded because coronary atherosclerotic plaques were inadequate for identification on MRA. Of the 37 patients, 18 patients had UAP and other 19 patients presented stable angina pectoris (SAP). Of the 37 plaques on CE-MRA, 13 and 24 plaques presented early enhancement and no enhancement, respectively. Of the 13 early-enhanced plaques, 11 (85%) and 2 (15%) were found in the patients with UAP and SAP, respectively (p < 0.01). Of the 37 patients, 11 (61%) with UAP and 2 (11%) with SAP had early-enhanced plaques, respectively (p < 0.01).

Conclusion

CE-MRA allows detection of early enhancement of coronary atherosclerotic plaque. The early enhancement is common in unstable angina and could be a sign of vulnerability.     

3.0T高分辨率CE-MRA对颈部血管狭窄的诊断价值

目的探讨三维对比增强磁共振血管成像(3D CE-MRA)在颈部动脉血管狭窄诊断中的临床应用价值。方法对23例临床拟诊颈部动脉血管狭窄行数字减影血管造影(DSA)的患者行颈部3D CE-MRA。将两种方法检查结果进行相关性比较。结果 23例患者共230个节段血管,3D CE-MRA显示了227个节段,共诊断出74处(32.6%)狭窄,其中28处轻度狭窄,22处中度狭窄,20处重度狭窄,4处闭塞;DSA共显示了230个节段的血管,共诊断出69处(30.4%)血管狭窄,其中24处轻度狭窄,23处中度狭窄,19处重度狭窄,3处闭塞。与DSA相比,3DCE-MRA对颈部动脉轻度、中度、重度狭窄及动脉闭塞的显示敏感性均为100%,特异性分别为85.71%、90.91%、90%和75%,两种检查方法对颈部动脉狭窄程度的判断有良好的一致性(κ=0.921,P=0.000)。结论 3.0T 3DCE-MRA能够可靠的评价颈部动脉狭窄性病变,基本可以替代DSA检查。     

颈动脉粥样斑块的多排螺旋CT血管造影及流行病学分布特征

目的:分析150例颈动脉粥样斑块病例,探讨其MDCTA表现及其临床流行病学分布特征。方法:经大范围MDCTA检查的颈动脉粥样斑块150例,所有病例均行彩色多谱勒超声检查,29例行DSA检查。应用横断面图像寻找斑块,根据病变的特点行2D、3D后处理,探讨其分布、形态、狭窄程度、钙化、不规则及溃疡等规律。根据斑块的钙化和纤维帽的完整性作为斑块风险性的评价指标,狭窄程度的判断采用NASCET标准。结果:150例病例中共发现317处斑块,其中,颈动脉起始部斑块37例,颈总动脉28例,颈动脉分叉部173例,颈内动脉44例,颈外动脉35例。轻、中、重狭窄及闭塞的发病率分别为30.95%、49.41%、16.96%及3.87%。分叉段斑块钙化率为64.7%,分叉段以外区域为23.9%。分叉段斑块不规则和溃疡的发病率为16.8%,分叉段以外为15.95%。分叉段狭窄程度以轻中度狭窄为主;分叉段以外以中重度狭窄比例高。结论:颈动脉不同区域粥样斑块的分布、形态、钙化和狭窄程度差异存在显著性意义,高风险斑块发病率相似,局限于分叉段的颈动脉检查可能漏诊高风险斑块。     

64排128层CT血管减影技术对头颈部血管狭窄或闭塞病变的诊断价值

目的探讨64排128层CT血管减影技术在头颈部血管狭窄和闭塞病变中的应用价值。 方法92例怀疑颅内外动脉狭窄或闭塞患者行64排128层CT血管减影检查,使用VR、Reformat、CPR等软件分析各血管狭窄或闭塞情况、斑块性质及狭窄与脑梗死间的关系。 结果65例患者颅内外血管均可见不同程度的狭窄或闭塞,以中、重度狭窄为主;113支血管有附壁粥样硬化斑块形成,钙化斑块、血管腔及硬化斑块CT值间差异有统计学意义(P<0.01);梗死侧颈动脉、大脑中动脉狭窄发生率与非梗死侧比较差异均有统计学意义(P均<0. 05)。 结论64排CT血管减影技术能够准确地评估血管狭窄和斑块性质,为临床治疗方法的选择提供有价值的信息。     

64层螺旋CT血管探针技术在颈部动脉狭窄评价中的应用

目的评价64层螺旋CT血管探针技术(vesselprobe,VP)对探测颈动脉狭窄程度、累及范围及斑块性质的能力,并与常规多平面重建(MPR)、曲面重建(CPR)相比较。方法 35例颈部血管CTA证实有颈动脉斑块患者均经64层螺旋CT双侧颈总动脉、颈内动脉及双侧椎动脉VP重组,以自动分析颈动脉狭窄程度、累及范围及斑块密度。获自VP的全部测量数据是回顾性分析的,并与MPR、CPR的测量数据进行了比较。结果 VP与MPR、CPR在探测颈动脉狭窄程度、累及范围及确定斑块性质方面比较,差异无统计学意义(P>0.05)。35例双侧颈动脉及椎动脉有斑块血管共84支,累及范围介于5.0～59.0 mm。大多数患者以局限性、混合性斑块及轻度血管狭窄为主。结论 64层螺旋CT时间分辨率与空间分辨率高,VP自动分析血管快速、可靠,能准确评价颈动脉狭窄程度、累及范围及斑块性质,对指导临床治疗具有重要意义。     

3D-Arterial analysis software and CEUS in the assessment of severity and vulnerability of carotid atherosclerotic plaque: a comparison with CTA and histopathology

Purpose

Our purpose is to assess Multiparametric Ultrasound (MPUS) efficacy for evaluation of carotid plaque vulnerability and carotid stenosis degree in comparison with Computed Tomography angiography (CTA) and histology.

Material and methods

3D-Arterial Analysis is a 3D ultrasound software that automatically provides the degree of carotid stenosis and a colorimetric map of carotid plaque vulnerability.

We enrolled 106 patients who were candidates for carotid endarterectomy. Prior to undergoing surgery, all carotid artery plaques were evaluated with Color-Doppler-US (CDUS), Contrast-Enhanced Ultrasound (CEUS), and 3D Arterial analysis (3DAA) US along with Computerized Tomographic Angiography (CTA) to assess the carotid artery stenosis degree. Post-surgery, the carotid specimens were fixed with 10% neutral buffered formalin solution, embedded in paraffin and used for light microscopic examination to assess plaque vulnerability morphological features.

Results

The results of the CTA examinations revealed 91 patients with severe carotid stenoses with a resultant diagnostic accuracy of 82.3% for CDUS, 94.5% for CEUS, 98.4% for 3DAA, respectively. The histopathological examination showed 71 vulnerable plaques with diagnostic accuracy values of 85.8% for CDUS, 93.4% for CEUS, 90.3% for 3DAA, 92% for CTA, respectively.

Conclusions

The combination of CEUS and 3D Arterial Analysis may provide a powerful new clinical tool to identify and stratify “at-risk” patients with atherosclerotic carotid artery disease, identifying vulnerable plaques. These applications may also help in the postoperative assessment of treatment options to manage cardiovascular risks.

     

缺血性脑血管病患者多层螺旋CT血管造影情况分析

目的根据螺旋CT血管造影（CTA）情况,探讨缺血性脑血管病患者颅内外血管粥样硬化斑块的性质、成分和动脉管腔狭窄程度与缺血性脑血管病的关系。方法选择缺血性脑血管病患者45例,经头颈部螺旋CT血管造影（CTA）,分析脑动脉管腔狭窄程度及动脉粥样斑块的性质、成分。结果45例患者中,CTA检出各种斑块（钙化斑、软斑、混合斑）33例（73．3％）,22例（48．8％）有动脉狭窄,血管闭塞5例。颅外动脉狭窄最常见的部位是颈内动脉起始部,颅内动脉狭窄最常见的部位是大脑中动脉M1段。结论缺血性脑血管病患者的颅内外动脉斑块发生率均较高,动脉粥样硬化致血管狭窄前循环发生率高于后循环,Ⅲ、Ⅳ级狭窄动脉相应供血区域大多出现缺血病灶,头颈动脉多层CTA可以准确评价颅内外动脉的病变情况,对脑卒中的二级预防具有重要指导意义。     

CT angiography in the assessment of carotid atherosclerotic disease: results of more than two years' experience

PURPOSE: To assess the role of CT Angiography (CTA) in patients with carotid atherosclerotic disease as compared to echo-colour Doppler (CDUS) ultrasound of the supra-aortic trunks (SAT) and surgery. MATERIALS AND METHODS: Eighty-two patients with suspected carotid atherosclerotic disease were submitted to CDUS and CTA of the supra-aortic trunks. Agreement between CDUS and CTA was first evaluated with regard to the following parameters: degree of stenosis according to NASCET criteria, plaque morphology, presence of ulcerations, tandem lesions and vessel abnormalities. Secondly, data provided by the two methodologies were compared with the surgical specimens (35 patients); in 12 cases, the stenosis was measured on the cast of the carotid plaque made of for biologic use silicone. RESULTS: The correlation between CDUS and CTA in evaluating the degree of stenosis was 75.6%; poor agreement was found for mild (61.1%) and severe (69.1%) stenoses; agreement in the evaluation of vessel abnormalities, plaque morphology and ulcerations was 81.7%, 89.0% and 96.3%, respectively. CTA demonstrated 11 tandem lesions not detected CDUS. Compared to surgery, CTA correctly classified the degree of stenosis according to NASCET criteria in 31/35 cases (88.6%) - as opposed to 29/35 by CDUS (82.9%) - and never overestimated the stenosis. CTA proved superior to CDUS in detecting plaque ulcerations (75% vs 25% sensitivity) and vessel abnormalities (100% vs 44.4% sensitivity). CONCLUSIONS: CTA is recommended as a second-level examination in patients with carotid atherosclerotic steno-obstructive disease who are surgical candidates.     

Dual-energy CT head bone and hard plaque removal for quantification of calcified carotid stenosis: utility and comparison with digital subtraction angiography

We evaluated quantification of calcified carotid stenosis by dual-energy (DE) CTA and dual-energy head bone and hard plaque removal (DE hard plaque removal) and compared the results to those of digital subtraction angiography (DSA). Eighteen vessels (13 patients) with densely calcified carotid stenosis were examined by dual-source CT in the dual-energy mode (tube voltages 140 kV and 80 kV). Head bone and hard plaques were removed from the dual-energy images by using commercial software. Carotid stenosis was quantified according to NASCET criteria on MIP images and DSA images at the same plane. Correlation between DE CTA and DSA was determined by cross tabulation. Accuracies for stenosis detection and grading were calculated. Stenosis could be evaluated in all vessels by DE CTA after applying DE hard plaque removal. In contrast, conventional CTA failed to show stenosis in 13 out of 18 vessels due to overlapping hard plaque. Good correlation between DE plaque removal images and DSA images was observed (r ² = 0.9504) for stenosis grading. Sensitivity and specificity to detect hemodynamically relevant (>70%) stenosis was 100% and 92%, respectively. Dual-energy head bone and hard plaque removal is a promising tool for the evaluation of densely calcified carotid stenosis.