title: Dual-energy CT head bone and hard plaque removal for quantification of calcified carotid stenosis: utility and comparison with digital subtraction angiography.
abstract: We evaluated quantification of calcified carotid stenosis by dual-energy (DE) CTA and dual-energy head bone and hard plaque removal (DE hard plaque removal) and compared the results to those of digital subtraction angiography (DSA). Eighteen vessels (13 patients) with densely calcified carotid stenosis were examined by dual-source CT in the dual-energy mode (tube voltages 140 kV and 80 kV). Head bone and hard plaques were removed from the dual-energy images by using commercial software. Carotid stenosis was quantified according to NASCET criteria on MIP images and DSA images at the same plane. Correlation between DE CTA and DSA was determined by cross tabulation. Accuracies for stenosis detection and grading were calculated. Stenosis could be evaluated in all vessels by DE CTA after applying DE hard plaque removal. In contrast, conventional CTA failed to show stenosis in 13 out of 18 vessels due to overlapping hard plaque. Good correlation between DE plaque removal images and DSA images was observed (r (2) = 0.9504) for stenosis grading. Sensitivity and specificity to detect hemodynamically relevant (>70%) stenosis was 100% and 92%, respectively. Dual-energy head bone and hard plaque removal is a promising tool for the evaluation of densely calcified carotid stenosis.
authors.affiliation: Department of Radiology, National Cardiovascular Center, Suita, Osaka, Japan. uota2@med.kobe-u.ac.jp
authors.forename: Kensuke
authors.initials: K
authors.lastname: Uotani
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Masahiro
authors.initials: M
authors.lastname: Higashi
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Nakazawa
authors.forename: Atsushi K
authors.initials: AK
authors.lastname: Kono
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Hori
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Fukuda
authors.forename: Suzu
authors.initials: S
authors.lastname: Kanzaki
authors.forename: Naoaki
authors.initials: N
authors.lastname: Yamada
authors.forename: Toshihide
authors.initials: T
authors.lastname: Itoh
authors.forename: Kazuro
authors.initials: K
authors.lastname: Sugimura
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Naito
mesh_terms: D015901:Angiography, Digital Subtraction / Q000379:methods*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012886:Skull / Q000000981:diagnostic imaging*; D013382:Subtraction Technique; D014057:Tomography, X-Ray Computed / Q000379:methods*