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Submitted: 03 July 2008 Modified: 24 September 2008
HERDIN Record #: PCHRD070508020724

The accuracy of CT angiography in assessing degree of stenosis in extracranial carotid arteries when compared with duplex ultrasonography in patients seen at the Philippine Heart Center .

Harold L. Tan,
Alfredo F. Villarosa

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Background ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ Atherosclerotic lesions of the extracranial cerebral arteries has always been primarily detected by conventional carotid angiography and duplex sonography. Conventional carotid angiography is the more invasive study and carries with it the risk of embolic complications among others. Although both modalities can give accurate quantification of stenosis, duplex ultrasonography provides the added feature of flow dynamics and plaque characterization. Its cost-effectiveness has made it the most widely-used solitary modality for diagnosing extracranial carotid artery pathology. With the advent of multidetector technology for CT scanners, it has become possible to reproduce images analogous to or even better than those offered by conventional angiography and duplex sonography, a specific protocol that has come to be known as CT angiography. The primary objective of this prospective study therefore is to determine if the degree of luminal stenosis diagnosed by duplex sonography could be accurately identified by CT angiography.

Results ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ The results of the duplex ultrasound and CT angiography were compared in 12 patient seen in the CT-MRI section of the Philippine Heart Center with a clinical suspicion of an obstructive lesion in the carotid arteries. A total of 148 segments were analyzed from the extracranial carotid artery, including the common, internal and external carotid arteries. A total of 121 normal segments (81.8 percent), 3 mild stenosis (2.0 percent), 5 moderate stenosis (3.3 percent), 9 severe stenosis (6.1 percent) and 4 complete occlusions (2.7 percent) were concordantly identified by duplex sonography and CT angiography. The statistical significance between the percentage values of stenoses demonstrated was evaluated by computing for the sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) with a 95 percent confidence interval.

Conclusion ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ This study shows that CT angiography is, although capable, is better as a complementary tool in cases in which duplex sonography is not as reliable and when an overall view of the vascular field is required. (Author)

Publication Type
Journal
Publication Sub Type
Announcements
Title
Philippine Heart Center Journal
Frequency
Quarterly
Publication Date
July-September 2006
Volume
12
Issue
3
Page(s)
65-69

Objectives

This study aims to determine if CT angiography of the extracranial carotid arteries will be able to accurately identify patients with significant stenosis diagnosed via duplex ultrasound. Specifically, this study aims to compare the ability of CT angiography in quantifying significant luminal stenosis, as well as to be able to differentiate between calcified and non-calcified plaque burden.

This study intends to prove that CT angiography of the extracranial carotid arteries will be able to diagnose
significant luminal stenosis comparable to duplex carotid ultrasonography.

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Philippine Council for Health Research and Development Library Abstract Print Format (Request Document)

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