Systematic Review of Computed Tomographic Angiography for Assessment of Carotid Artery Disease

Abstract

Background and Purpose-To review the literature on the diagnostic accuracy of computed tomographic angiography (CTA) compared with arteriography/intra-arterial digital subtraction angiography as reference standard for assessment of symptomatic carotid artery disease. Methods-The PubMed, MEDLINE, PREMEDLINE, EMBASE, and CINAHL databases were searched to retrieve studies published between 1990 and July 2003, comparing CTA and intra-arterial digital subtraction angiography in patients with symptomatic carotid artery disease that presented raw data for detection of a Ͻ70% or 70% to 99% stenosis or an occlusion. Two observers independently assessed methodological quality and constructed 2ϫ2 tables for sensitivity and specificity of CTA for detection of a 70% to 99% stenosis versus Ͻ70% stenosis or an occlusion, and for Ͻ99% stenosis versus occlusion. A bivariate random effects model was used to calculate the pooled sensitivity and specificity of CTA for detection of these lesions. Results-Some 864 patients (66% male) with a mean age of 66 years were studied in the 28 studies included in the meta-analysis. In all studies, a single-slice CT-scan was used. Only 8 studies satisfied all methodological quality criteria. The pooled sensitivity and specificity for detection of a 70% to 99% stenosis were 85% (95% CI, 79% to 89%) and 93% (95% CI, 89% to 96%), respectively. For detection of an occlusion, the sensitivity and specificity were 97% (95% CI, 93% to 99%) and 99% (95% CI, 98% to 100%), respectively. Incomplete reporting of demographic characteristics and technical differences in the individual studies obstructed a meaningful subgroup analysis. Conclusions-CTA is an accurate modality for detection of severe carotid artery disease, especially for detection of occlusions. The fair methodological quality of the included studies must be taken into account when interpreting these results.

Should We Be Concerned? Comparison of Catheter and CT Angiogram for Arterial Distensibility at the Site of Carotid Stenosis during Catheter Angiography

“…Modern CT angiography, performed with multidetector high-speed CT hardware, accurately and reliably depicts carotid disease and allows for direct quantification of carotid stenosis in millimeters [14] [15]. The accuracy of CTA for detection of severe carotid artery disease (70% to 90% stenosis), specifically carotid occlusions, was shown to be very comparable to the accuracy of CA; something that our data correlated well with [9] [16]. The combined use of duplex scanning and CTA has also been found to be accurate in the diagnosis of carotid occlusion and can replace angiography in cases of carotid occlusion [17] [18].…”

“…The internal carotid arteries (ICAs) identified as passing oblique to the axial plane were measured perpendicular to their own oblique axis as seen on the MPRs. The distal ICA was measured well past the bulb where the walls are parallel and no longer tapering from the carotid bulb as per NASCET [9] [10]. Millimeter measurements were obtained by using the sub-millimeter measurement and magnification tools on the PACS workstation.…”

Imaging of the Carotid Artery Vulnerable Plaque

“…In particular, CTA was accurate to characterize 70-99 % stenoses and for the diagnosis or exclusion of occlusions [101]. The ability to scan with very thin slices allows for the accurate evaluation of carotid plaques and of possible intimal irregularities or ulcerations.…”

Neuroimaging of ischemia and infarction

“…As for the assessment of carotid artery disease, a recent metanalysis comparing CTA with DSA showed CTA sensitivity and specificity of 85% and 93%, respectively, for high-grade carotid stenosis, and 97% and 99%, respectively, for carotid occlusion. 45 Three-dimensional (3D) arterial reconstructions contribute to the detection of carotid disease, but raw CTA-SI are more accurate for the assessment of any degree of stenosis (FIG. 2).…”