Skip to main content
SpringerLink
Log in

Diagnostik von Karotisstenosen mit der mehrzeiligen CT-Angiographie

Übersicht über die Literatur und Ergebnisse einer Pilotstudie

Diagnostic evaluation of carotid artery stenoses with multislice CT angiography

Review of the literature and results of a pilot study

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

Zusammenfassung

Hintergrund

Die Quantifizierung von Karotisstenosen ist für die therapeutische Indikationsstellung wichtig. Die DSA stellt den Goldstandard dar, wobei die verbesserte Zeit- und Ortsauflösung der mehrzeiligen CTA (MS-CTA) zu neuen Anwendungsmöglichkeiten der CTA geführt hat.

Material und Methoden

In einer Pilotstudie haben wir bei 9 Patienten (7m, 2w, Alter 60,7+/−10,9 Jahre) 14 Gefäße vergleichend mit biplanarer DSA und standardisierter 16-zeiliger CTA evaluiert. Messungen des Stenosegrades erfolgten in einem Konsensusreading nach modifizierten NASCET-Kriterien.

Ergebnisse

In der DSA zeigten sich 4 Okklusionen, 5 hochgradige (>70%) und 5 niedriggradige (<70%) Stenosen. Eine hochgradige infrapetröse Stenose konnte durch die schädelbasisnahe Topographie in der CTA nicht ausreichend quantifiziert werden. Im Bereich der Karotisbifurkation (n=13) ergab sich eine sehr gute Korrelation (Korrelationskoeffizient 0,99).

Schlussfolgerung

Die MS-CTA hat ein gutes diagnostisches Potenzial bei der Evaluation von Karotisstenosen, wobei weiterführende Studien zur Bestimmung der diagnostischen Wertigkeit bei unterschiedlichen Stenosearten notwendig sind.

Abstract

Background

The accurate evaluation of carotid artery stenoses is important for therapeutic decision making. Catheter digital subtraction angiography (DSA) still represents the gold standard, while the advent of multislice CT (MSCT) has led to improved temporal and spatial resolutions of CTA.

Material and methods

In a pilot study, we investigated 14 diseased vessels in 9 symptomatic patients (7m, 2f; mean age 60.7+/−10,9 years) comparing biplanar DSA with standardized 16-slice MS-CTA. The degree of stenosis was evaluated in a consensus reading following modified NASCET criteria.

Results

DSA demonstrated 4 occlusions, 5 high-grade stenoses (>70%) and 5 lower-grade stenoses (<70%). One dissecting, infrapetrous stenosis was not adequately quantified by CTA due to a close topographic relation to the skull base. In the carotid bifurcation (n=13), an excellent correlation was demonstrated between DSA and CTA with a correlation coefficient of 0.99.

Conclusion

MS-CTA has a good diagnostic potential in the evaluation of carotid artery stenoses. Larger studies will need to demonstrate the relative diagnostic value for different subtypes of stenosis and for different reader experience levels.

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. 1
Abb. 2
Abb. 3a, b
Abb. 4a–d

Literatur

  1. North American Symptomatic Carotid Endarterectomy Trial Collaborators (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325:445–453

    PubMed  Google Scholar 

  2. MRC European Carotid Surgery Trial (1996) Endarterectomy for moderate symptomatic carotid stenosis: interim results from the MRC European Carotid Surgery Trial. Lancet 347:1591–1593

    PubMed  Google Scholar 

  3. MRC European Carotid Surgery Trial (1991) Interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis. European Carotid Surgery Trialists‘ Collaborative Group. Lancet 337:1235–1243

    Article  PubMed  Google Scholar 

  4. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study (1995) Endarterectomy for asymptomatic carotid artery stenosis. JAMA 273:1421–1428

    PubMed  Google Scholar 

  5. Mas JL, Chatellier G, Beyssen B (2004) Carotid angioplasty and stenting with and without cerebral protection: clinical alert from the Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis (EVA-3S) trial. Stroke 35:18–20

    Google Scholar 

  6. Hobson RW 2nd (2003) Rationale and status of randomized controlled clinical trials in carotid artery stenting. Semin Vasc Surg 16:311–316

    Article  PubMed  Google Scholar 

  7. Hobson RW 2nd (2002) Update on the Carotid Revascularization Endarterectomy versus Stent Trial (CREST) protocol. J Am Coll Surg 194:S9–14

    Article  PubMed  Google Scholar 

  8. Dippel DW, van Kooten F, Bakker SL, Koudstaal PJ (1997) Interobserver agreement for 10% categories of angiographic carotid stenosis. Stroke 28:2483–2485

    CAS  PubMed  Google Scholar 

  9. Eliasziw M, Fox AJ, Sharpe BL, Barnett HJ (1997) Carotid artery stenosis: external validity of the North American Symptomatic Carotid Endarterectomy Trial measurement method. Radiology 204:229–233

    CAS  PubMed  Google Scholar 

  10. Young GR, Sandercock PA, Slattery J, Humphrey PR, Smith ET, Brock L (1996) Observer variation in the interpretation of intra-arterial angiograms and the risk of inappropriate decisions about carotid endarterectomy. J Neurol Neurosurg Psychiatry 60:152–157

    CAS  PubMed  Google Scholar 

  11. Benes V, Netuka D, Mandys V et al. (2004) Comparison between degree of carotid stenosis observed at angiography and in histological examination. Acta Neurochir (Wien) 146:671–677

    CAS  Google Scholar 

  12. Naylor AR, Rothwell PM, Bell PR (2003) Overview of the principal results and secondary analyses from the European and North American randomized trials of endarterectomy for symptomatic carotid stenosis. Eur J Vasc Endovasc Surg 26:115–129

    Article  CAS  PubMed  Google Scholar 

  13. Walker LJ, Ismail A, McMeekin W, Lambert D, Mendelow AD, Birchall D (2002) Computed tomography angiography for the evaluation of carotid atherosclerotic plaque: correlation with histopathology of endarterectomy specimens. Stroke 33:977–981

    Article  PubMed  Google Scholar 

  14. Long A, Lepoutre A, Corbillon E, Branchereau A (2002) Critical review of non- or minimally invasive methods (duplex ultrasonography, MR- and CT-angiography) for evaluating stenosis of the proximal internal carotid artery. Eur J Vasc Endovasc Surg 24:43–52

    Article  CAS  PubMed  Google Scholar 

  15. Elmore JR, Franklin DP, Thomas DD, Youkey JR (1998) Carotid endarterectomy: the mandate for high quality duplex. Ann Vasc Surg 12:156–162

    Article  CAS  PubMed  Google Scholar 

  16. Perkins JM, Galland RB, Simmons MJ, Magee TR (2000) Carotid duplex imaging: variation and validation. Br J Surg 87:320–322

    Article  CAS  PubMed  Google Scholar 

  17. Serfaty JM, Chirossel P, Chevallier JM, Ecochard R, Froment JC, Douek PC (2000) Accuracy of three-dimensional gadolinium-enhanced MR angiography in the assessment of extracranial carotid artery disease. AJR Am J Roentgenol 175:455–463

    CAS  PubMed  Google Scholar 

  18. Patel MR, Kuntz KM, Klufas RA et al. (1995) Preoperative assessment of the carotid bifurcation. Can magnetic resonance angiography and duplex ultrasonography replace contrast arteriography? Stroke 26:1753–1758

    CAS  PubMed  Google Scholar 

  19. Johnson MB, Wilkinson ID, Wattam J, Venables GS, Griffiths PD (2000) Comparison of Doppler ultrasound, magnetic resonance angiographic techniques and catheter angiography in evaluation of carotid stenosis. Clin Radiol 55:912–920

    Article  CAS  PubMed  Google Scholar 

  20. Remonda L, Heid O, Schroth G (1998) Carotid artery stenosis, occlusion, and pseudo-occlusion: first-pass, gadolinium-enhanced, three-dimensional MR angiography—preliminary study. Radiology 209:95–102

    CAS  PubMed  Google Scholar 

  21. Leclerc X, Godefroy O, Lucas C et al. (1999) Internal carotid arterial stenosis: CT angiography with volume rendering. Radiology 210:673–682

    CAS  PubMed  Google Scholar 

  22. Leclerc X, Godefroy O, Pruvo JP, Leys D (1995) Computed tomographic angiography for the evaluation of carotid artery stenosis. Stroke 26:1577–1581

    CAS  PubMed  Google Scholar 

  23. 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 

  24. 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 

  25. Dillon EH, van Leeuwen MS, Fernandez MA, Eikelboom BC, Mali WP (1993) CT angiography: application to the evaluation of carotid artery stenosis. Radiology 189:211–219

    CAS  PubMed  Google Scholar 

  26. Ertl-Wagner B, Hoffmann RT, Bruning R, Dichgans M, Reiser MF (2002) Diagnostic evaluation of the craniocervical vascular system with a 16-slice multi-detector row spiral CT. Protocols and first experiences. Radiologe 42:728–732

    Article  CAS  PubMed  Google Scholar 

  27. Nabavi DG, Kloska SP, Nam EM et al. (2002) MOSAIC: multimodal stroke assessment using computed tomography: novel diagnostic approach for the prediction of infarction size and clinical outcome. Stroke 33:2819–2826

    Article  PubMed  Google Scholar 

  28. Tomandl BF, Klotz E, Handschu R et al. (2003) Comprehensive imaging of ischemic stroke with multisection CT. Radiographics 23:565–592

    PubMed  Google Scholar 

  29. Lell M, Wildberger JE, Heuschmid M et al. (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 

  30. Chen CJ, Lee TH, Hsu HL et al. (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 

  31. De Monti M, Ghilardi G, Caverni L et al. (2003) Multidetector helical angio CT oblique reconstructions orthogonal to internal carotid artery for preoperative evaluation of stenosis. A prospective study of comparison with color Doppler US, digital subtraction angiography and intraoperative data. Minerva Cardioangiol 51:373–385

    PubMed  Google Scholar 

  32. Gerhards A, Raab P, Herber S, Kreitner KF, Boskamp T, Mildenberger P (2004) [Software-assisted CT-postprocessing of the carotid arteries]. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 176:870–874

    Article  CAS  PubMed  Google Scholar 

  33. 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 

  34. Klingebiel R, Zimmer C, Rogalla P et al. (2001) Assessment of the arteriovenous cerebrovascular system by multi-slice CT. A single-bolus, monophasic protocol. Acta Radiol 42:560–562

    CAS  PubMed  Google Scholar 

  35. Brüning R, Flohr T (2003) Protocols for multislice CT. Springer, Berlin Heidelberg New York

  36. Ertl-Wagner BB, Hoffmann RT, Bruning R et al. (2004) Multidetector row CT angiography of the brain at various kilovoltage settings. Radiology 231:528–535

    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 Klinische Radiologie, Klinikum Großhadern der Ludwig-Maximilians-Universität München

    B. Ertl-Wagner, R.-T. Hoffmann & M. F. Reiser

  2. Abteilung für Neuroradiologie, Klinikum Großhadern der Ludwig-Maximilians-Universität München

    R. Brüning

  3. Abteilung für Gefäßchirurgie/Klinik für Chirurgie, Klinikum Großhadern der Ludwig-Maximilians-Universität München

    G. Meimarakis

  4. Institut für Klinische Radiologie, Klinikum Großhadern der Ludwig-Maximilians-Universität, Marchioninistraße 15, 81377 , München

    B. Ertl-Wagner

Authors
  1. B. Ertl-Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Brüning
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R.-T. Hoffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Meimarakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. F. Reiser
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Ertl-Wagner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ertl-Wagner, B., Brüning, R., Hoffmann, RT. et al. Diagnostik von Karotisstenosen mit der mehrzeiligen CT-Angiographie. Radiologe 44, 960–966 (2004). https://doi.org/10.1007/s00117-004-1108-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00117-004-1108-7

Schlüsselwörter

Keywords

Search

Navigation