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Computed Tomography Angiography and Magnetic Resonance Angiography of the Carotids

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Noninvasive Vascular Diagnosis

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Abstract

Duplex ultrasonography is usually the initial study used to evaluate carotid artery disease. It provides an accurate noninvasive tool to determine the degree of carotid stenosis and plaque morphology. Although this study has a high sensitivity and specificity, it is an operator-dependent study.

Computed tomography angiography (CTA) has been widely used to evaluate carotid artery stenosis. It has a high sensitivity, specificity, and accuracy and provides additional information about the conformation and composition of the plaque. It is less susceptible than magnetic resonance angiography (MRA) in overestimating the severity of carotid stenosis. It is extremely fast and offers submillimeter spatial resolution, is less expensive than contrast-enhanced MRA, and has the ability to visualize soft tissue, bone, and blood vessels at the same time. CTA can interrogate the arterial tree from the aortic arch to the circle of Willis. It cannot be used to evaluate flow dynamics or for the diagnosis of subclavian steal or other flow-based lesions. It carries a risk for ionizing radiation and contrast-induced nephropathy. Currently, CTA is not used in patients with acute renal failure unless other modalities are not available.

MRA has the advantage of being noninvasive, does not require iodinated contrast or ionizing radiation, and provides an unlimited number of projections of the carotid lumen from a single acquisition. MRA can assess intrathoracic and intracranial lesions that are not amenable to duplex interrogation. Using dedicated protocols, MRA can demonstrate specific plaque components, e.g., calcium, lipid, fibrocellular element, or thrombus within the plaques. Unfortunately, however, the use of MRA as a diagnostic tool for carotid stenosis is often dependent on local expertise and familiarity with the test.

Digital subtraction angiography (DSA) is the gold standard for the diagnosis of carotid artery disease, and it offers the highest resolution available for visualizing the carotid artery. It has multiple disadvantages, however, including risks associated with conscious sedation, ionizing radiation, and nephrotoxic contrast agents. It is associated with access-related complications, including atheroembolic disease, thrombosis, dissection, and bleeding. In addition, information regarding the cerebral circulation can be obtained simultaneously, including patency of the carotid siphon and middle cerebral artery. This chapter will summarize the role of each imaging modality in the diagnosis of carotid artery disease.

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Author information

Authors and Affiliations

  1. Department of Surgery, Division of Vascular/Endovascular Surgery, West Virginia University/Charleston Division, Charleston, WV, USA

    Michael Yacoub MD, RPVI

  2. Vascular Surgery, Charleston Area Medical Center, Charleston, WV, USA

    Zachary T. AbuRahma DO

Authors
  1. Michael Yacoub MD, RPVI
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  2. Zachary T. AbuRahma DO
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Corresponding author

Correspondence to Zachary T. AbuRahma DO .

Editor information

Editors and Affiliations

  1. Charleston, West Virginia, USA

    Ali F. AbuRahma

Review Questions

Review Questions

  1. 1.

    All of these factors may affect carotid duplex ultrasound velocity except:

    1. a.

      Contralateral carotid occlusion

    2. b.

      Gender

    3. c.

      Obesity

    4. d.

      Tortuosity

    5. e.

      All of the above

  2. 2.

    Which imaging modality is best for detecting total carotid occlusion:

    1. a.

      Duplex ultrasound

    2. b.

      MRA

    3. c.

      CTA

    4. d.

      None of the above

  3. 3.

    Risk factors associated with nephrogenic systemic fibrosis:

    1. a.

      Type of gadolinium administered

    2. b.

      Previous renal disease

    3. c.

      Acute inflammatory state

    4. d.

      Elevated phosphate levels

    5. e.

      All of the above

  4. 4.

    Which of the following are complications of DSA:

    1. a.

      Risk of stroke

    2. b.

      Risk of hematoma

    3. c.

      Risk of renal failure

    4. d.

      Risk of radiation exposure

    5. e.

      All of the above

  5. 5.

    DSA may be the preferred imaging modality:

    1. a.

      When there is discordance between two different imagings

    2. b.

      When intervention is possibly needed based on clinical exam

    3. c.

      In evaluation to definitively define flow lesions such as subclavian steal

    4. d.

      All of the above are true

Answer Key

  1. 1.

    e

  2. 2.

    c

  3. 3.

    e

  4. 4.

    e

  5. 5.

    d

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Yacoub, M., AbuRahma, Z.T. (2017). Computed Tomography Angiography and Magnetic Resonance Angiography of the Carotids. In: AbuRahma, A. (eds) Noninvasive Vascular Diagnosis. Springer, Cham. https://doi.org/10.1007/978-3-319-54760-2_18

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  • DOI: https://doi.org/10.1007/978-3-319-54760-2_18

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-54758-9

  • Online ISBN: 978-3-319-54760-2

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