title: Computed tomography angiography vs 3 T black-blood cardiovascular magnetic resonance for identification of symptomatic carotid plaques.
abstract: BACKGROUND
  The purpose of this prospective study was to perform a head-to-head comparison of the two methods most frequently used for evaluation of carotid plaque characteristics: Multi-detector Computed Tomography Angiography (MDCTA) and black-blood 3 T-cardiovascular magnetic resonance (bb-CMR) with respect to their ability to identify symptomatic carotid plaques.
  
  
  METHODS
  22 stroke unit patients with unilateral symptomatic carotid disease and >50% stenosis by duplex ultrasound underwent MDCTA and bb-CMR (TOF, pre- and post-contrast fsT1w-, and fsT2w- sequences) within 15 days of symptom onset. Both symptomatic and contralateral asymptomatic sides were evaluated. By bb-CMR, plaque morphology, composition and prevalence of complicated AHA type VI lesions (AHA-LT6) were evaluated. By MDCTA, plaque type (non-calcified, mixed, calcified), plaque density in HU and presence of ulceration and/or thrombus were evaluated. Sensitivity (SE), specificity (SP), positive and negative predictive value (PPV, NPV) were calculated using a 2-by-2-table.
  
  
  RESULTS
  To distinguish between symptomatic and asymptomatic plaques AHA-LT6 was the best CMR variable and presence / absence of plaque ulceration was the best CT variable, resulting in a SE, SP, PPV and NPV of 80%, 80%, 80% and 80% for AHA-LT6 as assessed by bb-CMR and 40%, 95%, 89% and 61% for plaque ulceration as assessed by MDCTA. The combined SE, SP, PPV and NPV of bb-CMR and MDCTA was 85%, 75%, 77% and 83%, respectively.
  
  
  CONCLUSIONS
  Bb-CMR is superior to MDCTA at identifying symptomatic carotid plaques, while MDCTA offers high specificity at the cost of low sensitivity. Results were only slightly improved over bb-CMR alone when combining both techniques.
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany. jochen.grimm@chuv.ch.|Department of Medical Radiology, University Hospital and University of Lausanne, Lausanne, Switzerland. jochen.grimm@chuv.ch.
authors.forename: Jochen M
authors.initials: JM
authors.lastname: Grimm
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany. andreas.schindler@med.lmu.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schindler
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany. florian.schwarz@med.lmu.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Schwarz
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany. clemens.cyran@med.lmu.de.
authors.forename: Clemens C
authors.initials: CC
authors.lastname: Cyran
authors.affiliation: Institute for Stroke and Dementia Research, Ludwig-Maximilians-University Hospital Munich, Munich, Germany. anna.karpinska@med.lmu.de.
authors.forename: Anna
authors.initials: A
authors.lastname: Bayer-Karpinska
authors.affiliation: Department of Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany. tobias.freilinger@uni-tuebingen.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Freilinger
authors.affiliation: Department of Radiology, University of Washington School of Medicine, Seattle, USA. cyuan@u.washington.edu.
authors.forename: Chun
authors.initials: C
authors.lastname: Yuan
authors.affiliation: Department of Neuroradiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany. jennifer.linn@med.lmu.de.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Linn
authors.affiliation: Department of Radiology, University of Texas Medical Branch, Galveston, USA. mitrelle@utmb.edu.
authors.forename: Miguel
authors.initials: M
authors.lastname: Trelles
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany. maximilian.reiser@med.lmu.de.
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany. konstantin.nikolaou@med.lmu.de.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Nikolaou
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany. tobias.saam@med.lmu.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Saam
mesh_terms: D000368:Aged; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging* / Q000473:pathology*; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology