Window Settings for the Study of Calcified Carotid Plaques with Multidetector CT Angiography

SUMMARY: CT angiography (CTA) shows high sensitivity in detecting calcified plaques, but sometimes a bias in the exact quantification of stenosis degree occurs, mainly caused by the high linear attenuation coefficient of the calcified plaques. The purpose of this technical study was to evaluate the most appropriate CT window parameters for the assessment of calcified plaques stating which of them can provide the best inter-observer agreement. Scatter-plots and regression results showed the correlation between both width and level respectively depending on intraluminal Hounsfield units (HU) value (width = intraluminal HU × 2.07; level = intraluminal HU × 0.72). Obtained data indicated that the presence of different stenosis degrees did not modify visualization parameters.

[1]  Alfons G H Kessels,et al.  Assessment of human atherosclerotic carotid plaque components with multisequence MR imaging: initial experience. , 2005, Radiology.

[2]  P. Libby,et al.  Plaque instability--the real challenge for atherosclerosis research in the next decade? , 1999, Cardiovascular research.

[3]  C. Kramer,et al.  The Impact of Expansive Arterial Remodeling on Clinical Presentation in Carotid Artery Disease: A Multidetector CT Angiography Study , 2007, American Journal of Neuroradiology.

[4]  R. Virmani,et al.  Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. , 2000, Arteriosclerosis, thrombosis, and vascular biology.

[5]  D. Sackett,et al.  Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. , 1991, The New England journal of medicine.

[6]  L. Saba,et al.  Efficacy and sensitivity of axial scans and different reconstruction methods in the study of the ulcerated carotid plaque using multidetector-row CT angiography: comparison with surgical results. , 2007, AJNR. American journal of neuroradiology.

[7]  Akihiro Sato,et al.  Quantitative vascular measurements in arterial occlusive disease. , 2005, Radiographics : a review publication of the Radiological Society of North America, Inc.

[8]  Evaluation of contrast densities in the diagnosis of carotid stenosis by CT angiography. , 1997, AJR. American journal of roentgenology.

[9]  M. Cumming,et al.  Carotid artery stenosis: a prospective comparison of CT angiography and conventional angiography. , 1994, AJR. American journal of roentgenology.

[10]  Martin J Graves,et al.  Structural analysis and magnetic resonance imaging predict plaque vulnerability: a study comparing symptomatic and asymptomatic individuals. , 2007, Journal of vascular surgery.

[11]  Mathias Prokop,et al.  General principles of MDCT. , 2003, European journal of radiology.

[12]  S Meairs,et al.  Sonographic assessment of carotid artery stenosis. Comparison of power Doppler imaging and color Doppler flow imaging. , 1996, Stroke.

[13]  Renu Virmani,et al.  Histopathology of Carotid Atherosclerotic Disease , 2006, Neurosurgery.

[14]  Christopher M Kramer,et al.  Composition of the Stable Carotid Plaque: Insights From a Multidetector Computed Tomography Study of Plaque Volume , 2007, Stroke.

[15]  W. Lees,et al.  The appearance of normal and abnormal arterial morphology on intravascular ultrasound. , 1993, Clinical radiology.

[16]  P. Pattynama,et al.  Carotid plaque composition and cerebral infarction: MR imaging study. , 2005, AJNR. American journal of neuroradiology.

[17]  G. Adam,et al.  Multicontrast-weighted magnetic resonance imaging of atherosclerotic plaques at 3.0 and 1.5 Tesla: ex-vivo comparison with histopathologic correlation , 2006, European Radiology.

[18]  Juan Alvarez-Linera,et al.  Prospective evaluation of carotid artery stenosis: elliptic centric contrast-enhanced MR angiography and spiral CT angiography compared with digital subtraction angiography. , 2003, AJNR. American journal of neuroradiology.

[19]  B. Everitt,et al.  Statistical methods for rates and proportions , 1973 .

[20]  D. Sackett,et al.  Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. , 1998, The New England journal of medicine.

[21]  Carlo Catalano,et al.  Computed Tomography Angiography: State-of-the-Art Imaging Using Multidetector-Row Technology , 2004, Journal of computer assisted tomography.

[22]  S. Erickson,et al.  Stenosis of the internal carotid artery: assessment using color Doppler imaging compared with angiography. , 1989, AJR. American journal of roentgenology.

[23]  Erik Meijering,et al.  In Vivo Characterization and Quantification of Atherosclerotic Carotid Plaque Components With Multidetector Computed Tomography and Histopathological Correlation , 2006, Arteriosclerosis, thrombosis, and vascular biology.

[24]  Ernst Klotz,et al.  New techniques in CT angiography. , 2006, Radiographics : a review publication of the Radiological Society of North America, Inc.

[25]  W. Grove.  Statistical Methods for Rates and Proportions, 2nd ed , 1981 .

[26]  P. Wolf,et al.  Heart disease and stroke statistics--2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. , 2006, Circulation.

[27]  C. Kramer,et al.  Calcified carotid atherosclerotic plaque is associated less with ischemic symptoms than is noncalcified plaque on MDCT. , 2005, AJR. American journal of roentgenology.

[28]  A. Fox,et al.  Diagnosing carotid stenosis near-occlusion by using CT angiography. , 2006, AJNR. American journal of neuroradiology.

[29]  R Kikinis,et al.  Common carotid artery bifurcation: evaluation with spiral CT. Work in progress. , 1992, Radiology.

[30]  K. Hergan,et al.  Forty-slice spiral computed tomography of the coronary arteries: assessment of image quality and diagnostic accuracy in a non-selected patient population , 2007, Acta radiologica.

[31]  Geoffrey D Rubin,et al.  CT angiography of peripheral arterial disease. , 2006, Journal of vascular and interventional radiology : JVIR.

[32]  L. Saba,et al.  MDCTA of carotid plaque degree of stenosis: evaluation of interobserver agreement. , 2008, AJR. American journal of roentgenology.

[33]  M. Prokop,et al.  Use of maximum intensity projections in CT angiography: a basic review. , 1997, Radiographics : a review publication of the Radiological Society of North America, Inc.

[34]  J. Wardlaw,et al.  Atherosclerotic plaque at the carotid bifurcation: CT angiographic appearance with histopathologic correlation. , 1999, AJNR. American journal of neuroradiology.

[35]  L. Saba,et al.  Carotid artery wall thickness and ischemic symptoms: evaluation using multi-detector-row CT angiography , 2008, European Radiology.

[36]  I. Kullo,et al.  Vulnerable Plaque: Pathobiology and Clinical Implications , 1998, Annals of Internal Medicine.

[37]  E. Fishman,et al.  Three-dimensional volume rendering of spiral CT data: theory and method. , 1999, Radiographics : a review publication of the Radiological Society of North America, Inc.

[38]  H. Katano,et al.  Calcification in carotid atheromatous plaque: delineation by 3D-CT angiography, compared with pathological findings , 2004, Neurological research.

[39]  S. El-Saden,et al.  Imaging of the internal carotid artery: the dilemma of total versus near total occlusion. , 2001, Radiology.

[40]  J. Sablayrolles,et al.  Coronary computed tomography angiography: overview of technical aspects, current concepts, and perspectives. , 2007, Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes.

[41]  W S Kerwin,et al.  In Vivo Accuracy of Multispectral Magnetic Resonance Imaging for Identifying Lipid-Rich Necrotic Cores and Intraplaque Hemorrhage in Advanced Human Carotid Plaques , 2001, Circulation.

[42]  J. Ricotta.  Stenosis of the internal carotid artery: Assessment using color Doppler imaging compared with angiography: Erickson SJ, Mewissen MW, Foley WD, et al. AJR 1989; 152: 1299-305 , 1989 .

[43]  C Georg,et al.  Noninvasive detection and evaluation of atherosclerotic coronary plaques with multislice computed tomography. , 2001, Journal of the American College of Cardiology.

[44]  C. Yuan,et al.  Comparison of symptomatic and asymptomatic atherosclerotic carotid plaque features with in vivo MR imaging. , 2006, Radiology.

[45]  Michael L J Apuzzo.  Gravitas, Severitas, Veritas, Virtus. , 2006, Neurosurgery.

[46]  M. Wolverson,et al.  Ultrasonic tissue characterization of atheromatous plaques using a high resolution real time scanner. , 1983, Ultrasound in medicine & biology.

[47]  R. Vanninen,et al.  Multi-detector row CT angiography in the assessment of carotid artery disease in symptomatic patients: comparison with rotational angiography and digital subtraction angiography. , 2005, AJNR. American journal of neuroradiology.

[48]  Michael W Freckleton,et al.  Informatics in radiology (infoRAD): introduction to the language of three-dimensional imaging with multidetector CT. , 2005, Radiographics : a review publication of the Radiological Society of North America, Inc.

[49]  Massimo Midiri,et al.  3D reconstruction techniques made easy: know-how and pictures , 2005, European Radiology.

[50]  J. Bogousslavsky,et al.  Arterial wall imaging. , 2006, Frontiers of neurology and neuroscience.

[51]  Reiner Lenz,et al.  Evaluation of methods for shaded surface display of CT-volumes , 1988, [1988 Proceedings] 9th International Conference on Pattern Recognition.

[52]  G. Puppini,et al.  Characterisation of carotid atherosclerotic plaque: comparison between magnetic resonance imaging and histology , 2006, La radiologia medica.

[53]  J. Brossmann,et al.  Spiral CT angiography and selective digital subtraction angiography of internal carotid artery stenosis. , 1996, AJNR. American journal of neuroradiology.