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Imaging of the Internal Carotid Artery: The Dilemma of Total versus Near Total Occlusion¹

¹ From the Departments of Radiology (S.M.E., E.G.G., G.M.H., P.T.Z.), Neurology (S.N.C.), and Surgery (J.D.B.), West Los Angeles Veterans Administration Medical Center, 11301 Wilshire Blvd, Los Angeles, CA 90073. From the 1999 RSNA scientific assembly. Received October 2, 2000; revision requested November 15; revision received February 27, 2001; accepted March 30. Address correspondence to S.M.E. (e-mail: sels@mednet.ucla.edu).

PURPOSE: To evaluate ultrasonography (US) and magnetic resonance (MR) angiography in the differentiation between occlusion and near occlusion of internal carotid artery (ICA).

MATERIALS AND METHODS: Consecutive patients with occlusion or near occlusion of ICA at catheter angiography and who underwent MR angiography and US were included. MR angiography and US were compared with catheter angiography, the standard, for the ability to help distinguish occlusion from near occlusion. Noninvasive examinations were evaluated for the ability to classify near occlusions as having severe focal stenosis with distal luminal collapse versus diffuse nonfocal disease. The 95% CIs were calculated.

RESULTS: In 55 of 274 patients with 548 ICAs, catheter angiography depicted 37 total occlusions and 21 near occlusions. US depicted all total occlusions; MR angiography depicted 34 (92%) (95% CI: 0.78, 0.98). US depicted 18 (86%) of 21 (95% CI: 0.64, 0.97) near occlusions; MR angiography depicted all (100%). Of 18 vessels that were determined to be patent at US, 17 (94%) (95% CI: 0.73, 0.99) were classified as having focal stenosis or diffuse disease. Because flow gaps were identified in vessels with focal and diffuse disease, MR angiography was not effective in helping to differentiate these lesions.

CONCLUSION: Assuming US is the initial imaging examination, when occlusion is diagnosed, MR angiography can depict it. If occlusion is confirmed, no further imaging is necessary. US performed well in helping to differentiate vessels with focal severe stenosis from those with diffuse disease. MR angiography added little in this group. Catheter angiography remains beneficial for vessels with diffuse nonfocal narrowing.

Index terms: Angiography, comparative studies, 172.12142, 172.1245, 172.12981, 172.12983 • Carotid arteries, angiography, 172.12142, 172.12143, 172.1245, 172.12981, 172.12983 • Carotid arteries, stenosis or obstruction, 172.721

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