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.