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Carotid Arterial Stenosis: Evaluation at CT Angiography with the Volume-rendering Technique¹

¹ From the Departments of Radiology (C.D.M., V.J.L.M., J.L.B., B.P.M.), Vascular Surgery (C.C.), and Cardiothoracic Surgery (B.B.), Hôpital Robert Debré, C.H.U., Rue du Général Koenig, 51092 Reims, France. Received May 22, 1998; revision requested July 14; revision received September 9; accepted December 15. Address reprint requests to B.P.M.

View larger version (14K): [in a new window]   Figure 1. Graph of CT scan data as classified by a trapezoid. Point C represents the nominal attenuation value for the contrast material. Points B and D are the maximum variation acceptable for point C such that the voxel number still represents this contrast material entirely. Points A and E correspond to the minimum and maximum attenuation levels, respectively, of a voxel that contains none of the contrast material.

View larger version (16K): [in a new window]   Figure 2. Graph shows linear regression analysis results for the three observers for the degree of stenosis determined with VRT and SSD CT angiograms and DSA images. The dashed line indicates perfect correlation between CT angiography and DSA. The regression lines for VRT and SSD CT angiography are almost identical to each other. CTA = CT angiography.

View larger version (120K): [in a new window]   Figure 3a. Left carotid bifurcation in a 75-year-old man with severe stenosis. (a) DSA image, oblique view, shows severe stenosis (arrow) of the internal carotid artery. (b) Spiral VRT CT angiogram of the left carotid artery in the lateral projection shows severe stenosis (long arrow) of the internal carotid artery. Two small calcifications (short arrows) are seen as filling defects above the stenosis. The internal jugular vein (arrowhead) obscures the distal portion of the internal carotid artery. (c) Spiral SSD CT angiogram in the lateral view shows severe stenosis of the internal carotid artery (arrow). The internal jugular vein (arrowhead) is again noted.

View larger version (66K): [in a new window]   Figure 3b. Left carotid bifurcation in a 75-year-old man with severe stenosis. (a) DSA image, oblique view, shows severe stenosis (arrow) of the internal carotid artery. (b) Spiral VRT CT angiogram of the left carotid artery in the lateral projection shows severe stenosis (long arrow) of the internal carotid artery. Two small calcifications (short arrows) are seen as filling defects above the stenosis. The internal jugular vein (arrowhead) obscures the distal portion of the internal carotid artery. (c) Spiral SSD CT angiogram in the lateral view shows severe stenosis of the internal carotid artery (arrow). The internal jugular vein (arrowhead) is again noted.

View larger version (65K): [in a new window]   Figure 3c. Left carotid bifurcation in a 75-year-old man with severe stenosis. (a) DSA image, oblique view, shows severe stenosis (arrow) of the internal carotid artery. (b) Spiral VRT CT angiogram of the left carotid artery in the lateral projection shows severe stenosis (long arrow) of the internal carotid artery. Two small calcifications (short arrows) are seen as filling defects above the stenosis. The internal jugular vein (arrowhead) obscures the distal portion of the internal carotid artery. (c) Spiral SSD CT angiogram in the lateral view shows severe stenosis of the internal carotid artery (arrow). The internal jugular vein (arrowhead) is again noted.

View larger version (71K): [in a new window]   Figure 4a. Right carotid bifurcation in a 68-year-old man with two stenotic lesions. (a) DSA image, in the oblique projection, shows two severe stenoses (arrows) of the internal carotid artery. (b) Spiral VRT CT angiogram of the right carotid artery in the oblique projection fails to demonstrate hemodynamically significant stenoses of the internal carotid artery (arrows).

View larger version (54K): [in a new window]   Figure 4b. Right carotid bifurcation in a 68-year-old man with two stenotic lesions. (a) DSA image, in the oblique projection, shows two severe stenoses (arrows) of the internal carotid artery. (b) Spiral VRT CT angiogram of the right carotid artery in the oblique projection fails to demonstrate hemodynamically significant stenoses of the internal carotid artery (arrows).

View larger version (88K): [in a new window]   Figure 5a. Left carotid arterial bifurcation in a 71-year-old man with hemodynamically significant stenosis. (a) DSA image, anterior projection, shows severe stenosis (arrow) of the internal carotid artery. (b) Spiral VRT CT angiogram of the left carotid artery in the lateral projection shows severe stenosis (long solid arrow). The calcification (short solid arrow at lower portion) is seen as a mural filling defect and allows analysis of the residual lumen. Note the artifact (arrowhead) due to high-attenuation dental material. The assessment of stenosis severity was achieved by subtracting the high-attenuation rim (open arrows) from the narrowest diameter of the residual vascular lumen. (c) Spiral SSD CT angiogram in the lateral view with segmentation of the calcified plaque shows a severe stenosis (arrow). Note the artifact due to high-attenuation dental material (arrowhead).

View larger version (58K): [in a new window]   Figure 5b. Left carotid arterial bifurcation in a 71-year-old man with hemodynamically significant stenosis. (a) DSA image, anterior projection, shows severe stenosis (arrow) of the internal carotid artery. (b) Spiral VRT CT angiogram of the left carotid artery in the lateral projection shows severe stenosis (long solid arrow). The calcification (short solid arrow at lower portion) is seen as a mural filling defect and allows analysis of the residual lumen. Note the artifact (arrowhead) due to high-attenuation dental material. The assessment of stenosis severity was achieved by subtracting the high-attenuation rim (open arrows) from the narrowest diameter of the residual vascular lumen. (c) Spiral SSD CT angiogram in the lateral view with segmentation of the calcified plaque shows a severe stenosis (arrow). Note the artifact due to high-attenuation dental material (arrowhead).

View larger version (43K): [in a new window]   Figure 5c. Left carotid arterial bifurcation in a 71-year-old man with hemodynamically significant stenosis. (a) DSA image, anterior projection, shows severe stenosis (arrow) of the internal carotid artery. (b) Spiral VRT CT angiogram of the left carotid artery in the lateral projection shows severe stenosis (long solid arrow). The calcification (short solid arrow at lower portion) is seen as a mural filling defect and allows analysis of the residual lumen. Note the artifact (arrowhead) due to high-attenuation dental material. The assessment of stenosis severity was achieved by subtracting the high-attenuation rim (open arrows) from the narrowest diameter of the residual vascular lumen. (c) Spiral SSD CT angiogram in the lateral view with segmentation of the calcified plaque shows a severe stenosis (arrow). Note the artifact due to high-attenuation dental material (arrowhead).