Abstract:
HTML
Purpose: Plaque morphology and composition are commonly considered important in acute cerebro-vascular thrombo-embolic events; several studies have shown that surface irregularities and ulceration are associated with more frequent symptoms. We assessed the effectiveness of multidetector-row CT angiography (MDCTA) in characterizing carotid plaque in patients undergoing carotid endoarterectomy
Methods and Materials: 50 patients undergoing carotid endoarterectomy were enrolled into this prospective study. MDCTA was performed using a high resolution protocol with 4x1 mm collimation, slice thickness 1.25 mm and slice interval 0.7 mm, with an acquisition volume from the aortic arch to the intracranial circulation. Delay time was determined using the test bolus technique (16 mL at 4 mL/s). 80 mL of contrast agent were injected at a flow rate of 4 mL/s. After endoarterectomy, gross and histologic analysis were performed; at gross analysis the degree of stenosis and irregularities of the plaque were evaluated, while for microscopic analysis multiple sections of the specimens through the carotid bifurcation were examined hystologically. On CT transverse images plaque density was measured (in Hounsfield units) and the presence of lipidic core, hemorrhage, extent of fibrosis, ulceration and calcifications were recorded
Results: 50 carotid specimens and 140 transverse sections were available for pathological examination. Sensitivity, specificity and accuracy of MDCTA were respectively 97, 98 and 95% for the degree of stenosis and 98, 100 and 97% for irregularities of the plaque. Microscopic findings showed 12 pathological specimens with a lipidic core which was often hemorrhagic; 16 sections showed variable extent of fibrosis; 39 showed calcifications and 8 sections presented ulceration. Eleven of the 12 lipidic plaques with a pattern of patchy or homogeneous low density were correctly depicted at MDCTA; all cases of fibrosis and calcifications were correctly evaluated; ulceration was correctly assessed at MDCTA in 5 out of 8 cases. All the three ulcers undetected at MDCT were smaller than 2 mm.
Conclusion: MDCTA appears an accurate technique in the assessment of macroscopic findings (degree of stenosis and irregularities of the plaque); a correlation between histological appearance and plaque density was also seen for the prediction of lipidic core, fibrosis and calcifications; small in size ulcerations may not be revealed by MDCTA. Nevertheless MDCTA appears particularly useful for the prediction of plaque stability
Questions about this event email: fragola73@hotmail.com
Fraioli MD, F,
Multi Detector-row CT Angiography for the Evaluation of Carotid Atherosclerotic Plaque: Correlation with Histopathology of Endoarterectomy Specimens in 50 Consecutive Patients. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3106807.html
