Skip to main content
SpringerLink
Log in

CTA der A. carotis mit unterschiedlichen CT-Geräten

CTA of carotid artery with different scanner types

  • Karotisstenosen
  • Published:
Der Radiologe Aims and scope Submit manuscript

Zusammenfassung

Nichtinvasive Verfahren wie die CTA verdrängen zunehmend die DSA bei der präoperativen Abklärung von Patienten mit Karotisstenosen.

Die zuverlässige Beurteilung von Karotisstenosen erfordert ein dediziertes und standardisiertes Untersuchungsprotokoll, das für unterschiedliche CT-Scanner angepasst werden muss. Eine Darstellung der für die Therapieentscheidung wichtigsten Abschnitte der A. carotis ist mit allen modernen Spiral-CT-Geräten möglich. Die Verwendung hochauflösender Untersuchungsprotokolle und die Wahl geeigneter Rekonstruktionsalgorithmen verbessern die Abgrenzbarkeit der Plaques sowie des Restlumens bei Karotisstenosen. Die Darstellung der realistischen Stentdicke und Instentstenosen gelingt derzeit nicht. Ein standardisiertes Postprocessing ist die Grundlage für reproduzierbare Messergebnisse.

Die Stenosegraduierung ist bei Verwendung geeigneter Untersuchungsprotokolle mit der Mehrzeilen-Spiral-CT zuverlässig durchführbar. Bei Vierschichtgeräten ist noch mit einer deutlichen venösen Kontrastierung sowie Pulsationsartefakten am Aortenbogen und der proximalen A. carotis communis zu rechnen, aufgrund der kurzen Untersuchungszeit treten diese Probleme bei den Geräten der neuesten Generation in den Hintergrund.

Abstract

Noninvasive modalities like CTA are increasingly replacing selective angiography in the evaluation of carotid artery stenosis.

Dedicated scan protocols and contrast injection techniques are mandatory for the morphological assessment of carotid artery stenosis. These protocols need to be adapted to different scanner types.

The delineation of plaque components and the residual lumen is improved with high resolution scan protocols and dedicated reconstruction algorithms. The exact delineation of in-stent stenosis remains limited. Standardization of postprocessing is crucial in order to attain reproducible results.

Multislice spiral CT allows reliable grading of carotid artery stenosis. Relevant venous opacification and pulsation artifacts have to be expected with 4-slice scanners, the short scan time of the latest CT scanners minimize these problems.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1a–e
Abb. 2
Abb. 3
Abb. 4a–c
Abb. 5a–d
Abb. 6a–d
Abb. 7a–d
Abb. 8a–d

Literatur

  1. Rothwell PM, Eliasziw M, Gutnikov SA, Fox AJ, Taylor DW, Mayberg MR, Warlow CP, Barnett HJ (2003) Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 361:107–116

    Article  CAS  PubMed  Google Scholar 

  2. Elgersma OE, Buijs PC, Wust AF, van der Graaf Y, Eikelboom BC, Mali WP (1999) Maximum internal carotid arterial stenosis: assessment with rotational angiography versus conventional intraarterial digital subtraction angiography. Radiology 213:777–783

    CAS  PubMed  Google Scholar 

  3. Hirai T, Korogi Y, Ono K, Murata Y, Takahashi M, Suginohara K, Uemura S (2001) Maximum stenosis of extracranial internal carotid artery: effect of luminal morphology on stenosis measurement by using CT angiography and conventional DSA. Radiology 221:802–809

    CAS  PubMed  Google Scholar 

  4. Nederkoorn PJ, Elgersma OE, Mali WP, Eikelboom BC, Kappelle LJ, van der Graaf Y (2002) Overestimation of carotid artery stenosis with magnetic resonance angiography compared with digital subtraction angiography. J Vasc Surg 36:806–813

    Article  PubMed  Google Scholar 

  5. Nederkoorn PJ, Elgersma OE, van der Graaf Y, Eikelboom BC, Kappelle LJ, Mali WP (2003) Carotid artery stenosis: accuracy of contrast-enhanced MR angiography for diagnosis. Radiology 228:677–682

    PubMed  Google Scholar 

  6. Randoux B, Marro B, Marsault C (2004) Carotid artery stenosis: competition between CT angiography and MR angiography. AJNR Am J Neuroradiol 25:663–664; author reply 664

    Google Scholar 

  7. Grant EG, Benson CB, Moneta GL et al. (2003) Carotid artery stenosis: grayscale and Doppler ultrasound diagnosis. Society of Radiologists in Ultrasound Consensus Conference. Ultrasound Q 19:190–198

    Article  PubMed  Google Scholar 

  8. Staikov IN, Nedeltchev K, Arnold M, Remonda L, Schroth G, Sturzenegger M, Herrmann C, Rivoir A, Mattle HP (2002) Duplex sonographic criteria for measuring carotid stenoses. J Clin Ultrasound 30:275–281

    Article  PubMed  Google Scholar 

  9. Nonent M, Serfaty JM, Nighoghossian N et al. (2004) Concordance rate differences of 3 noninvasive imaging techniques to measure carotid stenosis in clinical routine practice: results of the CARMEDAS Multicenter Study. Stroke 35:682–686

    Article  PubMed  Google Scholar 

  10. Gupta AK, Nelson RC, Johnson GA, Paulson EK, Delong DM, Yoshizumi TT (2003) Optimization of eight-element multi-detector row helical CT technology for evaluation of the abdomen. Radiology 227:739–745

    PubMed  Google Scholar 

  11. Fleischmann D, Rubin GD, Bankier AA, Hittmair K (2000) Improved uniformity of aortic enhancement with customized contrast medium injection protocols at CT angiography. Radiology 214:363–371

    CAS  PubMed  Google Scholar 

  12. Fleischmann D (2003) Use of high concentration contrast media: principles and rationale-vascular district. Eur J Radiol 45 [suppl 1]:S88–93

    Google Scholar 

  13. Mahnken AH, Buecker A, Wildberger JE, Ruebben A, Stanzel S, Vogt F, Gunther RW, Blindt R (2004) Coronary artery stents in multislice computed tomography: in vitro artifact evaluation. Invest Radiol 39:27–33

    Article  PubMed  Google Scholar 

  14. Leclerc X, Gauvrit JY, Pruvo JP (2000) Usefulness of CT angiography with volume rendering after carotid angioplasty and stenting. AJR Am J Roentgenol 174:820–822

    CAS  PubMed  Google Scholar 

  15. Verhoek G, Costello P, Khoo EW, Wu R, Kat E, Fitridge RA (1999) Carotid bifurcation CT angiography: assessment of interactive volume rendering. J Comput Assist Tomogr 23:590–596

    Article  CAS  PubMed  Google Scholar 

  16. Leclerc X, Godefroy O, Lucas C, Benhaim JF, Michel TS, Leys D, Pruvo JP (1999) Internal carotid arterial stenosis: CT angiography with volume rendering. Radiology 210:673–682

    CAS  PubMed  Google Scholar 

  17. Addis KA, Hopper KD, Iyriboz TA, Liu Y, Wise SW, Kasales CJ, Blebea JS, Mauger DT (2001) CT angiography: in vitro comparison of five reconstruction methods. AJR Am J Roentgenol 177:1171–1176

    CAS  PubMed  Google Scholar 

  18. Lell M, Wildberger JE, Heuschmid M, Flohr T, Stierstorfer K, Fellner FA, Lang W, Bautz WA, Baum U (2002) CT-angiography of the carotid artery: first results with a novel 16-slice-spiral-CT scanner. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 174:1165–1169

    Article  CAS  PubMed  Google Scholar 

  19. Fox AJ (1993) How to measure carotid stenosis. Radiology 186:316–318

    CAS  PubMed  Google Scholar 

  20. Nikolaou K, Becker CR, Wintersperger BJ, Rist C, Trumm C, Leber A, Babaryka G, Reiser MF (2004) Evaluating multislice computed tomography for imaging coronary atherosclerosis. Radiologe 44:130–139

    Article  CAS  PubMed  Google Scholar 

  21. Dix JE, Evans AJ, Kallmes DF, Sobel AH, Phillips CD (1997) Accuracy and precision of CT angiography in a model of carotid artery bifurcation stenosis. AJNR Am J Neuroradiol 18:409–415

    CAS  PubMed  Google Scholar 

  22. Lev MH, Ackerman RH, Chehade RJ et al. (1996) Accurate spiral CT angiographic measurement of carotid artery luminal diameter: a phantom study (abstr). Radiology 201:117

    Google Scholar 

  23. Liu Y, Hopper KD, Mauger DT, Addis KA (2000) CT angiographic measurement of the carotid artery: optimizing visualization by manipulating window and level settings and contrast material attenuation. Radiology 217:494–500

    CAS  PubMed  Google Scholar 

  24. Zhang Z, Berg MH, Ikonen AE, Vanninen RL, Manninen HI (2004) Carotid artery stenosis: reproducibility of automated 3D CT angiography analysis method. Eur Radiol 14:665–672

    Article  PubMed  Google Scholar 

  25. Anderson GB, Ashforth R, Steinke DE, Ferdinandy R, Findlay JM (2000) CT angiography for the detection and characterization of carotid artery bifurcation disease. Stroke 31:2168–2174

    CAS  PubMed  Google Scholar 

  26. Randoux B, Marro B, Koskas F, Duyme M, Sahel M, Zouaoui A, Marsault C (2001) Carotid artery stenosis: prospective comparison of CT, three-dimensional gadolinium-enhanced MR, and conventional angiography. Radiology 220:179–185

    CAS  PubMed  Google Scholar 

  27. Fraioli F, Catalano C, Pediconi F, Napoli A, Fanelli F, Danti M, Passariello R (2003) Multislice angiography of the carotid arteries: diagnostic accuracy and interobserver variability in comparison with selective catheter angiography. Eur Radiol 13 [suppl 1]:317

    Google Scholar 

  28. Pediconi F, Catalano C, Fraioli F, Napoli A, Fanelli F, Finocchi V, Danti M, Passariello R (2003) Prospective comparison of multislice CT angiography (MSCTA), contrast enhanced MR angiography (CE-MRA) and digital subtraction angiography (DSA) in patients with carotid artery stenosis. Eur Radiol 13 [suppl 1]:318

    Google Scholar 

  29. Chen CJ, Lee TH, Hsu HL, Tseng YC, Lin SK, Wang LJ, Wong YC (2004) Multislice CT angiography in diagnosing total versus near occlusions of the internal carotid artery: comparison with catheter angiography. Stroke 35:83–85

    Article  CAS  PubMed  Google Scholar 

  30. Kalender WA, Schmidt B, Zankl M, Schmidt M (1999) A PC program for estimating organ dose and effective dose values in computed tomography. Eur Radiol 9:555–562

    Article  CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Institut für Diagnostische Radiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg

    M. Lell, K. Anders, W. Bautz & M. Uder

  2. Institut für Medizinische Physik, Friedrich-Alexander-Universität Erlangen-Nürnberg

    C. Leidecker

  3. Abteilung für Gefäßchirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg

    W. Lang

  4. Institut für Diagnostische Radiologie, Friedrich-Alexander-Universität, Maximiliansplatz 1, 91054 , Erlangen

    M. Lell

Authors
  1. M. Lell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Anders
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Leidecker
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. W. Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W. Bautz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Uder
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Lell.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lell, M., Anders, K., Leidecker, C. et al. CTA der A. carotis mit unterschiedlichen CT-Geräten. Radiologe 44, 967–974 (2004). https://doi.org/10.1007/s00117-004-1106-9

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00117-004-1106-9

Schlüsselwörter

Keywords

Search

Navigation