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

PURPOSE: 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.

MATERIALS AND METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

References

  • 1 Kannel WB. Current status of the epidemiology of brain infarction associated with occlusive arterial disease. Stroke 1971; 2:295-318. Crossref, MedlineGoogle Scholar
  • 2 Heiserman JE, Dean BL, Hodak JA, et al. Neurologic complications of cerebral angiography. AJNR Am J Neuroradiol 1994; 15:1401-1407. MedlineGoogle 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; 325:445-453. Crossref, MedlineGoogle Scholar
  • 4 Collaborative Group. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis—European Carotid Surgery Trialists’. Lancet 1991; 337:1235-1243. Crossref, MedlineGoogle Scholar
  • 5 Barnett HJ, Taylor DW, Eliasziw M, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis: North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 1998; 339:1415-1425. Crossref, MedlineGoogle Scholar
  • 6 Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA 1995; 273:1421-1428. Crossref, MedlineGoogle Scholar
  • 7 Eliasziw M, Streifler JY, Fox AJ, Hachinski VC, Ferguson GG, Barnett HJ. Significance of plaque ulceration in symptomatic patients with high-grade carotid stenosis: North American Symptomatic Carotid Endarterectomy Trial. Stroke 1994; 25:304-308. Crossref, MedlineGoogle Scholar
  • 8 Hatsukami TS, Ferguson MS, Beach KW, et al. Carotid plaque morphology and clinical events. Stroke 1997; 28:95-100. Crossref, MedlineGoogle Scholar
  • 9 Streifler JY, Eliasziw M, Fox AJ, et al. Angiographic detection of carotid plaque ulceration: comparison with surgical observations in a multicenter study. Stroke 1994; 25:1130-1132. Crossref, MedlineGoogle Scholar
  • 10 Ho VB, Foo TK. Optimization of gadolinium-enhanced magnetic resonance angiography using an automated bolus-detection algorithm. Invest Radiol 1998; 33:515-523. Crossref, MedlineGoogle Scholar
  • 11 Castillo M, Wilson JD. CT angiography of the common carotid artery bifurcation: comparison between two techniques and conventional angiography. Neuroradiology 1994; 36:602-604. Crossref, MedlineGoogle Scholar
  • 12 Cumming MJ, Morrow IA. Carotid artery stenosis: a prospective comparison of CT angiography and conventional angiography. AJR Am J Roentgenol 1994; 163:517-523. Crossref, MedlineGoogle Scholar
  • 13 Leclerc X, Godefroy O, Pruvo JP, Leys D. Computed tomographic angiography for the evaluation of carotid artery stenosis. Stroke 1995; 26:1577-1581. Crossref, MedlineGoogle Scholar
  • 14 Schwartz RB, Jones KM, Chernoff DM, et al. Common carotid artery bifurcation: evaluation with spiral CT. Radiology 1992; 185:513-519. LinkGoogle Scholar
  • 15 Cinat M, Lane CT, Pham H, Lee A, Wilson SE, Gordon I. Helical CT angiography in the preoperative evaluation of carotid artery stenosis. J Vasc Surg 1998; 28:290-300. Crossref, MedlineGoogle Scholar
  • 16 Leclerc X, Martinat P, Godefroy O, et al. Contrast-enhanced three-dimensional fast imaging with steady-state precession (FISP) MR angiography of supraaortic vessels: preliminary results. AJNR Am J Neuroradiol 1998; 19:1405-1413. MedlineGoogle Scholar
  • 17 Slosman F, Stolpen AH, Lexa FJ, et al. Extracranial atherosclerotic carotid artery disease: evaluation of non-breath-hold three-dimensional gadolinium-enhanced MR angiography. AJR Am J Roentgenol 1998; 170:489-495. Crossref, MedlineGoogle Scholar
  • 18 Scarabino T, Carriero A, Magarelli N, et al. MR Angiography in carotid stenosis: a comparison of three techniques. Eur J Radiol 1998; 28:117-125. Crossref, MedlineGoogle Scholar
  • 19 Cronqvist M, Stahlberg F, Larsson EM, Lonntoft M, Holtas S. Evaluation of time-of-flight and phase-contrast MRA sequences at 1.0 T for diagnosis of carotid artery disease. I. A phantom and volunteer study. Acta Radiol 1996; 37:267-277. Crossref, MedlineGoogle Scholar
  • 20 Remonda L, Heid O, Schroth G. Carotid artery stenosis, occlusion, and pseudo-occlusion: first-pass, gadolinium-enhanced, three-dimensional MR angiography—preliminary study. Radiology 1998; 208:95-102. Google Scholar
  • 21 Levy RA, Prince MR. Arterial-phase three-dimensional contrast-enhanced MR angiography of the carotid arteries. AJR Am J Roentgenol 1996; 167:211-215. Crossref, MedlineGoogle Scholar
  • 22 Evans AJ, Richardson DB, Tien R, et al. Poststenotic signal loss in MR angiography: effects of echo time, flow compensation, and fractional echo. AJNR Am J Neuroradiol 1993; 14:721-729. MedlineGoogle Scholar
  • 23 Comerota AJ, Katz ML, White JV, Grosh JD. The preoperative diagnosis of the ulcerated carotid atheroma. J Vasc Surg 1990; 11:505-510. Crossref, MedlineGoogle Scholar
  • 24 Runge VM, Kirsch JE, Lee C. Contrast-enhanced MR angiography. J Magn Reson Imaging 1993; 3:233-239. Crossref, MedlineGoogle Scholar
  • 25 Marro B, Zouaoui A, Koskas F, et al. Computerized tomographic angiography scan following carotid endarterectomy. Ann Vasc Surg 1998; 12:451-456. Crossref, MedlineGoogle Scholar
  • 26 Vanninen R, Manninen H, Koivisto K, Tulla H, Partanen K, Puranen M. Carotid stenosis by digital subtraction angiography: reproducibility of the European Carotid Surgery Trial and the North American Symptomatic Carotid Endarterectomy Trial measurement methods and visual interpretation. AJNR Am J Neuroradiol 1994; 15:1635-1641. MedlineGoogle Scholar

Article History

Published in print: July 2001