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Maximum Stenosis of Extracranial Internal Carotid Artery: Effect of Luminal Morphology on Stenosis Measurement by Using CT Angiography and Conventional DSA¹

¹ From the Departments of Radiology (T.H., K.O., Y.M.) and Neurosurgery (K.S., S.U.), Amakusa Medical Center, 854-1 Kameba, Hondo, Kumamoto 863-0046, Japan; and Department of Radiology, Kumamoto University School of Medicine, Japan (Y.K., M.T.). Received November 1, 2000; revision requested December 23; revision received March 13, 2001; accepted April 18. Address correspondence to T.H. (e-mail: toshinor@beige.ocn.ne.jp).

PURPOSE: To assess the luminal morphology of the extracranial internal carotid artery at three-dimensional (3D) computed tomographic (CT) angiography and how this factor affects measurement of maximum carotid arterial stenoses at conventional intraarterial digital subtraction angiography (DSA).

MATERIALS AND METHODS: Prospectively, conventional intraarterial DSA and 3D CT angiography were performed in 42 carotid arteries in 21 patients with suspected carotid artery disease. The longest axis length–perpendicular axis length (L/P) ratios of the arterial lumen on the cross-sectional images at the most stenotic area and distal nonstenotic area were analyzed by acquiring multiplanar reconstruction (MPR) images at 3D CT angiography. The maximum stenosis was measured at each modality with North American Symptomatic Carotid Endarterectomy Trial criteria.

RESULTS: The L/P ratios in the most stenotic areas ranged from 1.0 to 3.2 (mean, 1.5 ± 0.5 [SD]). The mean difference in maximum percentage of stenosis between the two modalities for L/P ratios of 2.0 or greater was significantly greater than that for L/P ratios of less than 1.5 (P < .05). Three carotid arteries with 70%–99% stenosis, with grades determined with only 3D CT angiography, had L/P ratios of 2.0 or greater.

CONCLUSION: On MPR images at 3D CT angiography, the lumen of extracranial internal carotid artery stenosis showed a wide range of shapes. When a carotid artery has a high L/P ratio, the luminal morphology of the carotid artery stenosis may affect the assessment of maximum stenosis of the internal carotid artery at conventional DSA.

Index terms: Carotid arteries, angiography, 1722.1247 • Carotid arteries, CT, 1722.12113, 1722.12117 • Carotid arteries, stenosis or obstruction, 1722.721 • Computed tomography (CT), three-dimensional, 1722.12117 • Digital subtraction angiography, 1722.721 • Digital subtraction angiography, comparative studies

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