title: Dual energy CTA of the carotid bifurcation: advantage of plaque subtraction for assessment of grade of the stenosis and morphology.
abstract: OBJECTIVE
  Calcifications adjacent to the vessel lumen often limit the assessment of stenoses at the carotid bifurcation in 3D multi intensity projection images (3D-MIP) using conventional single energy CT. Aim of the study was to evaluate the diagnostic value of 3D-MIP images after subtraction of bone and calcified plaques (PBS) using dual energy CT for the assessment of carotid bifurcation stenoses.
  
  
  METHODS
  36 patients with a total of 46 stenoses at the carotid bifurcation were examined with a dual energy CT system. Grade of the stenoses and plaque morphology were assessed in axial multi planar projections (axMPR) and freely rotatable 3D-MIP images before and after PBS and compared with results from DSA.
  
  
  RESULTS
  Grade of the stenosis could be evaluated in all 46 cases in DSA, axMPR and 3D-MIP after PBS. However, in 25 cases grade of the stenosis was not assessable prior to PBS. The average grade of the stenosis increased from DSA (81.4%) to axMPR (83.5%) to 3D-MIP before and after PBS (86.5% and 85.6%). The amount of pseudo-occlusions increased in concordance with the grade of the stenosis (0<9<16). Using 3D-MIP reconstructions, plaque morphology could be evaluated in 32/46 stenoses before PBS and in 44/46 cases after PBS.
  
  
  CONCLUSIONS
  PBS facilitated the evaluation of grade of the stenosis in all cases. Nevertheless, after PBS stenoses were overrated in 3D-MIP in comparison to DSA and axMPR. Moreover, plaque morphology, as an independent risk factor for stroke, can be evaluated even in calcified plaques after PBS. Therefore dual energy CTA with plaque subtraction has the potential to identify patients with vulnerable plaques better than conventional CTA.
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany. an.korn@yahoo.de
authors.forename: A
authors.initials: A
authors.lastname: Korn
authors.forename: B
authors.initials: B
authors.lastname: Bender
authors.forename: C
authors.initials: C
authors.lastname: Thomas
authors.forename: S
authors.initials: S
authors.lastname: Danz
authors.forename: M
authors.initials: M
authors.lastname: Fenchel
authors.forename: T
authors.initials: T
authors.lastname: Nägele
authors.forename: M
authors.initials: M
authors.lastname: Heuschmid
authors.forename: U
authors.initials: U
authors.lastname: Ernemann
authors.forename: T K
authors.initials: TK
authors.lastname: Hauser
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods*; D002114:Calcinosis / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results