title: Arterial wall enhancement overlying carotid plaque on CT angiography correlates with symptoms in patients with high grade stenosis.
abstract: OBJECTIVE
  The degree of internal carotid artery (ICA) stenosis is an established primary risk factor for embolic stroke. Recent publications suggest that inflammatory features may also play an important role. Our purpose was to correlate acute neurological symptoms with either carotid artery wall enhancement or plaque calcification, on axial CT angiographic source images (CTA-SI) of patients with severe (>or=70%) ICA stenosis.
  
  
  METHODS
  75 consecutive patients with >or=70% ICA stenosis on CTA-SI were identified. Each case was classified as symptomatic (n=37) or asymptomatic (n=38), and as having either calcified or noncalcified plaque. The latter group was stratified into those with versus without arterial wall enhancement, measured in absolute and relative Hounsfield Units (HU).
  
  
  RESULTS
  Calcified plaque was present in 39% (15/38) of the symptomatic patients and in 62% (23/37) of the asymptomatic patients (P=0.065). Of the 37 patients without calcified plaque, carotid wall enhancement was observed in 83% (19/23) of the symptomatic, but only in 57% (8/14) of the asymptomatic patients (P=0.041). When the "calcified plaque" and "no carotid wall enhancement" groups were pooled, versus the "carotid wall enhancement" group, enhancement was more likely in symptomatic patients (OR 3.625, CI 95% 1.3229 to 9.93, P=0.01 Fisher Exact test).
  
  
  CONCLUSIONS
  In patients with severe ICA stenosis, additional stratification of stroke risk may be possible based on the presence of carotid wall enhancement on CTA-SI. Patients with carotid wall enhancement are more likely to be symptomatic, compared to those with either calcified plaque or no enhancement.
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. jmromero@partners.org
authors.forename: Javier M
authors.initials: JM
authors.lastname: Romero
authors.forename: Lukasz S
authors.initials: LS
authors.lastname: Babiarz
authors.forename: N Paola
authors.initials: NP
authors.lastname: Forero
authors.forename: Erin K
authors.initials: EK
authors.lastname: Murphy
authors.forename: Pamela W
authors.initials: PW
authors.lastname: Schaefer
authors.forename: R Gilberto
authors.initials: RG
authors.lastname: Gonzalez
authors.forename: Michael H
authors.initials: MH
authors.lastname: Lev
mesh_terms: D002114:Calcinosis / Q000000981:diagnostic imaging / Q000473:pathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000473:pathology*; D002533:Cerebral Angiography / Q000379:methods*; D015331:Cohort Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed