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Computed Tomography Angiography and Magnetic Resonance Angiography of the Carotids

  • Michael Yacoub
  • Zachary T. AbuRahmaEmail author
Chapter

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.

Keywords

CTA MRA Carotid disease Diagnosis 

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Surgery, Division of Vascular/Endovascular SurgeryWest Virginia University/Charleston DivisionCharlestonUSA
  2. 2.Vascular SurgeryCharleston Area Medical CenterCharlestonUSA

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