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Internal Carotid Arterial Stenosis: CT Angiography with Volume Rendering

¹ Departments of Neuroradiology (X.L., J.F.B., T.S.M., J.P.P.)
² Neurology (O.G., C.L., D.L.), Hôpital Roger Salengro, Boulevard du Professeur Leclercq, 59037 Lille, France.

View larger version (16K): [in a new window]   Figure 1. Trapezoid parameters relative to the voxel intensity histogram for the evaluation of carotid stenosis.

View larger version (95K): [in a new window]   Figure 2a. Left ICA stenosis. (a) Selective angiogram of the frontal view of the left carotid artery shows 80% stenosis (arrow) 2 cm from the origin of the ICA, with a carotid bulb (arrowhead) elongated in the transverse plane. (b) MIP CT image enables good evaluation of the residual lumen at the site of the stenosis (arrow). (c) Volume-rendered CT image demonstrates excellent delineation of the artery outlines and thereby enables accurate measurement of the stenosis (arrow). (d) Axial CT image obtained at the level of the stenosis appears inefficient to demonstrate the stenosis of the left ICA (arrow) because of the transverse orientation of the carotid bulb, which results in an inadequate scanning plane.

View larger version (62K): [in a new window]   Figure 2b. Left ICA stenosis. (a) Selective angiogram of the frontal view of the left carotid artery shows 80% stenosis (arrow) 2 cm from the origin of the ICA, with a carotid bulb (arrowhead) elongated in the transverse plane. (b) MIP CT image enables good evaluation of the residual lumen at the site of the stenosis (arrow). (c) Volume-rendered CT image demonstrates excellent delineation of the artery outlines and thereby enables accurate measurement of the stenosis (arrow). (d) Axial CT image obtained at the level of the stenosis appears inefficient to demonstrate the stenosis of the left ICA (arrow) because of the transverse orientation of the carotid bulb, which results in an inadequate scanning plane.

View larger version (66K): [in a new window]   Figure 2c. Left ICA stenosis. (a) Selective angiogram of the frontal view of the left carotid artery shows 80% stenosis (arrow) 2 cm from the origin of the ICA, with a carotid bulb (arrowhead) elongated in the transverse plane. (b) MIP CT image enables good evaluation of the residual lumen at the site of the stenosis (arrow). (c) Volume-rendered CT image demonstrates excellent delineation of the artery outlines and thereby enables accurate measurement of the stenosis (arrow). (d) Axial CT image obtained at the level of the stenosis appears inefficient to demonstrate the stenosis of the left ICA (arrow) because of the transverse orientation of the carotid bulb, which results in an inadequate scanning plane.

View larger version (120K): [in a new window]   Figure 2d. Left ICA stenosis. (a) Selective angiogram of the frontal view of the left carotid artery shows 80% stenosis (arrow) 2 cm from the origin of the ICA, with a carotid bulb (arrowhead) elongated in the transverse plane. (b) MIP CT image enables good evaluation of the residual lumen at the site of the stenosis (arrow). (c) Volume-rendered CT image demonstrates excellent delineation of the artery outlines and thereby enables accurate measurement of the stenosis (arrow). (d) Axial CT image obtained at the level of the stenosis appears inefficient to demonstrate the stenosis of the left ICA (arrow) because of the transverse orientation of the carotid bulb, which results in an inadequate scanning plane.

View larger version (92K): [in a new window]   Figure 3a. Right ICA stenosis. (a) Selective angiogram of the lateral view of the right carotid artery demonstrates near occlusion (arrow) with decreased diameter of the distal ICA (arrowhead). (b) Axial CT section obtained at the level of the stenosis shows substantial narrowing of the residual lumen (arrow) surrounded by low-attenuating atherosclerotic plaque (arrowhead). (c) MIP CT image reveals tight stenosis (arrow) and decreased diameter of the ICA (arrowhead) in accordance with the conventional angiogram. (d) Volume-rendered CT image does not depict the residual lumen at the site of the stenosis (arrow), but it shows reduced diameter of the distal ICA (arrowhead) and thereby enables correct classification of the severity of carotid stenosis.

View larger version (94K): [in a new window]   Figure 3b. Right ICA stenosis. (a) Selective angiogram of the lateral view of the right carotid artery demonstrates near occlusion (arrow) with decreased diameter of the distal ICA (arrowhead). (b) Axial CT section obtained at the level of the stenosis shows substantial narrowing of the residual lumen (arrow) surrounded by low-attenuating atherosclerotic plaque (arrowhead). (c) MIP CT image reveals tight stenosis (arrow) and decreased diameter of the ICA (arrowhead) in accordance with the conventional angiogram. (d) Volume-rendered CT image does not depict the residual lumen at the site of the stenosis (arrow), but it shows reduced diameter of the distal ICA (arrowhead) and thereby enables correct classification of the severity of carotid stenosis.

View larger version (71K): [in a new window]   Figure 3c. Right ICA stenosis. (a) Selective angiogram of the lateral view of the right carotid artery demonstrates near occlusion (arrow) with decreased diameter of the distal ICA (arrowhead). (b) Axial CT section obtained at the level of the stenosis shows substantial narrowing of the residual lumen (arrow) surrounded by low-attenuating atherosclerotic plaque (arrowhead). (c) MIP CT image reveals tight stenosis (arrow) and decreased diameter of the ICA (arrowhead) in accordance with the conventional angiogram. (d) Volume-rendered CT image does not depict the residual lumen at the site of the stenosis (arrow), but it shows reduced diameter of the distal ICA (arrowhead) and thereby enables correct classification of the severity of carotid stenosis.

View larger version (61K): [in a new window]   Figure 3d. Right ICA stenosis. (a) Selective angiogram of the lateral view of the right carotid artery demonstrates near occlusion (arrow) with decreased diameter of the distal ICA (arrowhead). (b) Axial CT section obtained at the level of the stenosis shows substantial narrowing of the residual lumen (arrow) surrounded by low-attenuating atherosclerotic plaque (arrowhead). (c) MIP CT image reveals tight stenosis (arrow) and decreased diameter of the ICA (arrowhead) in accordance with the conventional angiogram. (d) Volume-rendered CT image does not depict the residual lumen at the site of the stenosis (arrow), but it shows reduced diameter of the distal ICA (arrowhead) and thereby enables correct classification of the severity of carotid stenosis.

View larger version (98K): [in a new window]   Figure 4a. Left ICA stenosis with calcification. (a) Conventional angiogram of the oblique view of the left carotid artery shows 80% ICA stenosis (arrow). (b) Axial CT image obtained at the origin of the left ICA demonstrates a concentric mural calcification (arrow) surrounding a narrowed enhancing residual lumen (arrowhead). (c) MIP CT image shows a dense calcification obscuring the stenosis in its initial portion (arrow). The narrowing (arrowhead) was measured above the calcification and found to be moderate. (d) Volume-rendered CT image depicts the entire portion of the stenosis (arrowhead) with accuracy despite the calcification.

View larger version (111K): [in a new window]   Figure 4b. Left ICA stenosis with calcification. (a) Conventional angiogram of the oblique view of the left carotid artery shows 80% ICA stenosis (arrow). (b) Axial CT image obtained at the origin of the left ICA demonstrates a concentric mural calcification (arrow) surrounding a narrowed enhancing residual lumen (arrowhead). (c) MIP CT image shows a dense calcification obscuring the stenosis in its initial portion (arrow). The narrowing (arrowhead) was measured above the calcification and found to be moderate. (d) Volume-rendered CT image depicts the entire portion of the stenosis (arrowhead) with accuracy despite the calcification.

View larger version (100K): [in a new window]   Figure 4c. Left ICA stenosis with calcification. (a) Conventional angiogram of the oblique view of the left carotid artery shows 80% ICA stenosis (arrow). (b) Axial CT image obtained at the origin of the left ICA demonstrates a concentric mural calcification (arrow) surrounding a narrowed enhancing residual lumen (arrowhead). (c) MIP CT image shows a dense calcification obscuring the stenosis in its initial portion (arrow). The narrowing (arrowhead) was measured above the calcification and found to be moderate. (d) Volume-rendered CT image depicts the entire portion of the stenosis (arrowhead) with accuracy despite the calcification.

View larger version (110K): [in a new window]   Figure 4d. Left ICA stenosis with calcification. (a) Conventional angiogram of the oblique view of the left carotid artery shows 80% ICA stenosis (arrow). (b) Axial CT image obtained at the origin of the left ICA demonstrates a concentric mural calcification (arrow) surrounding a narrowed enhancing residual lumen (arrowhead). (c) MIP CT image shows a dense calcification obscuring the stenosis in its initial portion (arrow). The narrowing (arrowhead) was measured above the calcification and found to be moderate. (d) Volume-rendered CT image depicts the entire portion of the stenosis (arrowhead) with accuracy despite the calcification.

View larger version (102K): [in a new window]   Figure 5a. Proximal ICA stenosis. (a) Selective angiogram of the oblique view of the proximal ICA (arrow) shows 35% stenosis with a carotid loop (arrowhead). (b) MIP CT image demonstrates dense calcification of the carotid bifurcation (arrow), which prevents analysis of the arterial lumen. (c) Volume-rendered CT image enables accurate evaluation of the arterial lumen (arrow) through the calcifications (arrowhead) owing to the different opacity values.

View larger version (100K): [in a new window]   Figure 5b. Proximal ICA stenosis. (a) Selective angiogram of the oblique view of the proximal ICA (arrow) shows 35% stenosis with a carotid loop (arrowhead). (b) MIP CT image demonstrates dense calcification of the carotid bifurcation (arrow), which prevents analysis of the arterial lumen. (c) Volume-rendered CT image enables accurate evaluation of the arterial lumen (arrow) through the calcifications (arrowhead) owing to the different opacity values.

View larger version (85K): [in a new window]   Figure 5c. Proximal ICA stenosis. (a) Selective angiogram of the oblique view of the proximal ICA (arrow) shows 35% stenosis with a carotid loop (arrowhead). (b) MIP CT image demonstrates dense calcification of the carotid bifurcation (arrow), which prevents analysis of the arterial lumen. (c) Volume-rendered CT image enables accurate evaluation of the arterial lumen (arrow) through the calcifications (arrowhead) owing to the different opacity values.

View larger version (97K): [in a new window]   Figure 6a. Proximal ICA stenosis with ulcer. (a) Conventional angiogram of the lateral view of the right carotid artery shows 40% stenosis of the proximal ICA (arrow) with a 3-mm ulcer (arrowhead) of the posterior wall of the bulb. (b) MIP CT image shows the stenosis (arrow) and the ulcer (arrowhead) to have similar appearances compared with their appearances on the conventional angiogram. (c) Volume-rendered CT image demonstrates the stenosis (arrow) and the ulcer (arrowhead), with good delineation of the artery outlines. (d) Axial CT image demonstrates the posterior ulcer (arrow) well separated from the residual lumen (arrowhead).

View larger version (66K): [in a new window]   Figure 6b. Proximal ICA stenosis with ulcer. (a) Conventional angiogram of the lateral view of the right carotid artery shows 40% stenosis of the proximal ICA (arrow) with a 3-mm ulcer (arrowhead) of the posterior wall of the bulb. (b) MIP CT image shows the stenosis (arrow) and the ulcer (arrowhead) to have similar appearances compared with their appearances on the conventional angiogram. (c) Volume-rendered CT image demonstrates the stenosis (arrow) and the ulcer (arrowhead), with good delineation of the artery outlines. (d) Axial CT image demonstrates the posterior ulcer (arrow) well separated from the residual lumen (arrowhead).

View larger version (82K): [in a new window]   Figure 6c. Proximal ICA stenosis with ulcer. (a) Conventional angiogram of the lateral view of the right carotid artery shows 40% stenosis of the proximal ICA (arrow) with a 3-mm ulcer (arrowhead) of the posterior wall of the bulb. (b) MIP CT image shows the stenosis (arrow) and the ulcer (arrowhead) to have similar appearances compared with their appearances on the conventional angiogram. (c) Volume-rendered CT image demonstrates the stenosis (arrow) and the ulcer (arrowhead), with good delineation of the artery outlines. (d) Axial CT image demonstrates the posterior ulcer (arrow) well separated from the residual lumen (arrowhead).

View larger version (110K): [in a new window]   Figure 6d. Proximal ICA stenosis with ulcer. (a) Conventional angiogram of the lateral view of the right carotid artery shows 40% stenosis of the proximal ICA (arrow) with a 3-mm ulcer (arrowhead) of the posterior wall of the bulb. (b) MIP CT image shows the stenosis (arrow) and the ulcer (arrowhead) to have similar appearances compared with their appearances on the conventional angiogram. (c) Volume-rendered CT image demonstrates the stenosis (arrow) and the ulcer (arrowhead), with good delineation of the artery outlines. (d) Axial CT image demonstrates the posterior ulcer (arrow) well separated from the residual lumen (arrowhead).

View larger version (20K): [in a new window]   Figure 7a. Percentages of carotid arterial stenosis, as measured with conventional angiography, plotted against measurements obtained with (a) axial, (b) MIP, and (c) volume-rendered CT (VRT).

View larger version (19K): [in a new window]   Figure 7b. Percentages of carotid arterial stenosis, as measured with conventional angiography, plotted against measurements obtained with (a) axial, (b) MIP, and (c) volume-rendered CT (VRT).

View larger version (19K): [in a new window]   Figure 7c. Percentages of carotid arterial stenosis, as measured with conventional angiography, plotted against measurements obtained with (a) axial, (b) MIP, and (c) volume-rendered CT (VRT).