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Carotid artery plaque characteristics: current reporting practices on CT angiography

  • Diagnostic Neuroradiology
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Abstract

Purpose

Extracranial ICA imaging has largely focused on the degree of luminal stenosis, but recent advances suggest specific plaque features are crucial in stroke risk assessment. We evaluated the current state of reporting carotid plaque features on neck CTAs at an academic institution.

Methods

In this retrospective observational study, we included neck CTAs performed on patients over age 50 with any reported carotid plaque. We evaluated reports for mention of the following: degree of luminal stenosis, soft plaque, calcified plaque, plaque thickness, quantification of soft and calcified plaque, plaque ulceration, and increased risk associated with specific features. We used Fisher’s exact test to compare how often each feature was mentioned.

Results

We included a total of 651 reports from unique patients (mean age, 68.1 ± 13.3 years). A total of 639 reports (98.1%) explicitly mentioned degree of stenosis per NASCET criteria. Specific plaque features were less frequently characterized: soft plaque in 116 (17.8%); calcified plaque in 166 (25.5%); quantification of the amount of soft plaque and calcified plaque in 24 (3.7%) and 16 (2.5%) reports, respectively; plaque thickness in 12 (1.8%); plaque ulceration in 476 (73.1%); and increased risk associated with plaque in 2 (0.3%). Degree of stenosis was statistically more likely to be mentioned than any other plaque feature (p < 0.001).

Conclusion

Currently, nearly all reports mention the degree of luminal stenosis on neck CTAs while a significant minority mention specific plaque features. Despite mounting evidence of the importance of carotid plaque features in stroke risk assessment, radiology reports do not routinely report these findings.

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Funding

This work was supported by the Association of University Radiologists - GE Radiology Research Academic Fellowship, NIH R01HL144541 and R21HL145427, and American Heart Association (grant number 17SDG33460420).

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Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A141, Salt Lake City, UT, 84135, USA

    Hediyeh Baradaran, Tyrel Foster, Paul Harrie, J. Scott McNally, Matthew Alexander & Yoshimi Anzai

  2. Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Ankur Pandya

  3. Department of Radiology, Weill Cornell Medicine, New York, NY, USA

    Ajay Gupta

  4. Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA

    Ajay Gupta

Authors
  1. Hediyeh Baradaran
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  2. Tyrel Foster
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  4. J. Scott McNally
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  5. Matthew Alexander
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  6. Ankur Pandya
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  7. Yoshimi Anzai
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  8. Ajay Gupta
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Contributions

All authors on this submission (Hediyeh Baradaran, Tyrel Foster, Paul Harrie, J Scott McNally, Matthew Alexander, Ankur Pandya, Yoshimi Anzai, and Ajay Gupta) (1) made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; (2) drafted the work or revised it critically for important intellectual content; (3) approved the version to be published; and (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Hediyeh Baradaran.

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The authors declare no relevant conflicts of interest.

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All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was waived for this retrospective study.

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Baradaran, H., Foster, T., Harrie, P. et al. Carotid artery plaque characteristics: current reporting practices on CT angiography. Neuroradiology 63, 1013–1018 (2021). https://doi.org/10.1007/s00234-020-02610-w

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