Unknown internal carotid artery atherosclerotic stenoses detected with biphasic multidetector computed tomography for head and neck cancer

The possibility of detecting unknown internal carotid artery stenoses in patients undergoing biphasic multidetector computed tomography (MDCT) for current or previous head and neck cancer was investigated in 52 patients who underwent four-row MDCT (4 mm×1.25 mm collimation, pitch 3, kVp 120, mAs 140; 90–100 ml of non-ionic contrast agent at 2 ml/s, early and late phases). Vessel stenoses were classed as severe (70–99%), moderate (30–69%), or mild (<30%). Internal carotid arteries (ICAs) with vessel stenosis was found in 37 patients (age 67.0±9.8 years, median 69 years) and 67 ICAs. Four patients (age 65.5±9.7 years) had severe stenosis, all of them associated with contralateral moderate stenosis. Seventeen patients (age 70.35±9.78 years) had moderate stenosis, bilateral (n=7), associated with contralateral mild stenosis (n=8), unilateral (n=2). Sixteen patients (age 64.8±9.8 years) had mild stenosis, bilateral (n=10) or unilateral (n=6). Of the four patients with unknown MDCT-detected severe stenosis, three had a change of therapy: one endarterectomy before tumor surgery, one combined vascular and tumor surgery, and one patient with a previously treated hypopharyngeal cancer had carotid stenting. In conclusion, of 52 patients, four (7.7 %) had unknown severe ICA stenoses, three of them with relevant impact on therapy. ICAs should be carefully evaluated for atherosclerotic disease using biphasic MDCT for head and neck cancer.