Computed Tomography Imaging in Carotid Artery Stenosis

  • M. Berg
  • R. Vanninen
  • H. Manninen


Since the advent of computed tomography (CT) equipment for clinical imaging, the development of spiral (or helical) CT with a slip ring scanner was the main step towards the evolution of CT angiography. Continuous CT spiral scanning with breathholding of the patient and simultaneous patient transport through the gantry allowed volumetric imaging of whole organs without discontinuities [29], [17]. This rapid spiral volumetric CT scanning permitted imaging of the organs optimally in the arterial or venous phase during the first pass of an intravenously injected bolus of contrast media. Soon after spiral CT scanning was introduced in 1990, several of the first reports on the clinical applications of spiral CT concentrated on CT angiography [16], [47], [68], [25]. With a singledetector spiral CT scanner (SDCT), rapid volumetric scanning increased image noise slightly and induced a minor decrease in the z-axis resolution compared to previous sequential technique, but did not decrease the diagnostic quality of the study [11].


Compute Tomography Angiography Carotid Stenosis Spiral Compute Tomography Carotid Artery Stenosis Stenosis Degree 
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  1. [1]
    Alvarez-Linera J, Benito-Leon J, Escribano J et al.: Prospective evaluation of carotid artery stenosis: elliptic centric contrast-enhanced MR angiography and spiral CT angiography compared with digital subtraction angiography. AJNR 24: 1012–1019 (2003).PubMedGoogle Scholar
  2. [2]
    Anderson GB, Ashforth R, Steinke DE et al.: CT angiography for the detection and characterization of carotid artery bifurcation disease. Stroke 31: 2168–2174 (2000).PubMedGoogle Scholar
  3. [3]
    Bae KT, Heiken JP, Brink JA: Aortic and hepatic contrast medium enhancement at CT. Part I. Prediction with a computer model. Radiology 207: 647–655 (1998).PubMedGoogle Scholar
  4. [4]
    Berg M, Zhang Z, Ikonen A et al.: Multi-detector row CT angiography in the assessment of carotid artery disease in symptomatic patients: comparison with rotational angiography and digital subtraction angiography. AJNR 26: 1022–1034 (2005).PubMedGoogle Scholar
  5. [5]
    Berg MH, Manninen HI, Rasanen HT et al.: CT angiography in the assessment of carotid artery atherosclerosis. Acta Radiol 43: 116–124 (2002).PubMedGoogle Scholar
  6. [6]
    Berland LL, Smith JK: Multidetector-array CT: once again, technology creates new opportunities [editorial; comment]. Radiology 209: 327–329 (1998).PubMedGoogle Scholar
  7. [7]
    Binaghi S, Maeder P, Uske A et al.: Three-dimensional computed tomography angiography and magnetic resonance angiography of carotid bifurcation stenosis. Eur Neurol 46: 25–34 (2001).PubMedCrossRefGoogle Scholar
  8. [8]
    Brink JA: Contrast optimization and scan timing for single and multidetector-row computed tomography. J Comput Assist Tomogr 27: S3–S8 (2003).PubMedGoogle Scholar
  9. [9]
    Brink JA: Technical aspects of helical (spiral) CT. Radiol Clin North Am 33: 825–841 (1995).PubMedGoogle Scholar
  10. [10]
    Brink JA, Lim JT, Wang G et al.: Technical optimization of spiral CT for depiction of renal artery stenosis: in vitro analysis. Radiology 194: 157–163 (1995).PubMedGoogle Scholar
  11. [11]
    Brink JA, Heiken JP, Balfe DM et al.: Spiral CT: decreased spatial resolution in vivo due to broadening of section-sensitivity profile. Radiology 185: 469–474 (1992).PubMedGoogle Scholar
  12. [12]
    Calhoun PS, Kuszyk BS, Heath DG et al.: Three-dimensional volume rendering of spiral CT data: theory and method. Radiographics 19: 745–764 (1999).PubMedGoogle Scholar
  13. [13]
    Casey SO, Alberico RA, Patel M et al.: Cerebral CT venography. Radiology 198: 163–170 (1996).PubMedGoogle Scholar
  14. [14]
    Cinat M, Lane CT, Pham H, Lee A, Wilson SE, Gordon I: Helical CT angiography in the preoperative evaluation of carotid artery stenosis. J Vasc Surg 28: 290–300 (1998).PubMedCrossRefGoogle Scholar
  15. [15]
    Chen CJ, Lee TH, Hsu HL et al.: Multi-Slice CT angiography in diagnosing total versus near occlusions of the internal carotid artery: comparison with catheter angiography. Stroke 35: 83–85 (2004).PubMedCrossRefGoogle Scholar
  16. [16]
    Costello P, Ecker CP, Tello R et al.: Assessment of the thoracic aorta by spiral CT. AJR 158: 1127–1130 (1992).PubMedGoogle Scholar
  17. [17]
    Crawford CR, King KF: Computed tomography scanning with simultaneous patient translation. Med Phys 17: 967–982 (1990).PubMedCrossRefGoogle Scholar
  18. [18]
    Davis SM: Extracranial and intracranial atheroma as causes of stroke. In: Cerebrovascular disease: (Myron D, Ginsberg JB, eds.). Pathophysiology, diagnosis, and management. pp 1373–1391. Malden: Blackwell Science (1998).Google Scholar
  19. [19]
    Derdeyn CP: Catheter angiography is still necessary for the measurement of carotid stenosis. AJNR 24: 1737–1738 (2003).PubMedGoogle Scholar
  20. [20]
    ECST: Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 351: 1379–1387 (1998).CrossRefGoogle Scholar
  21. [21]
    Fleischmann D: Use of high concentration contrast media: principles and rationale-vascular district. Eur J Radiol 2003 45: S88–S93.PubMedCrossRefGoogle Scholar
  22. [22]
    Fleischmann D, Rubin GD, Bankier AA et al.: Improved uniformity of aortic enhancement with customized contrast medium injection protocols at CT angiography. Radiology 214: 363–371 (2000).PubMedGoogle Scholar
  23. [23]
    Flohr TG, Schaller S, Stierstorfer K et al.: Multi-detector row CT systems and image-reconstruction techniques. Radiology 235: 756–773 (2005).PubMedGoogle Scholar
  24. [24]
    Foley WD, Karcaaltincaba M: Computed tomography angiography: principles and clinical applications. J Comput Assist Tomogr 27: S23–S30 2(2003).PubMedGoogle Scholar
  25. [25]
    Galanski M, Prokop M, Chavan A et al.: Renal arterial stenoses: spiral CT angiography. Radiology 189: 185–192 (1993).PubMedGoogle Scholar
  26. [26]
    Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ: Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 316: 1371–1375 (1987).PubMedCrossRefGoogle Scholar
  27. [27]
    Hatsukami TS, Ferguson MS, Beach KW et al.: Carotid plaque morphology and clinical events. Stroke 28: 95–100 (1997).PubMedGoogle Scholar
  28. [28]
    Kalender WA, Prokop M: 3D CT angiography. Crit Rev Diagn Imaging 42: 1–28 (2001).PubMedGoogle Scholar
  29. [29]
    Kalender WA, Seissler W, Klotz E et al.: Spiral volumetric CT with single-breath-hold technique, continuous transport, and continuous scanner rotation. Radiology 176: 181–183 (1990).PubMedGoogle Scholar
  30. [30]
    Kasales CJ, Hopper KD, Ariola DN et al.: Reconstructed helical CT scans: improvement in z-axis resolution compared with overlapped and nonoverlapped conventional CT scans. AJR 164: 1281–1284 (1995).PubMedGoogle Scholar
  31. [31]
    Katz DA, Marks MP, Napel SA et al.: Circle of Willis: evaluation with spiral CT angiography, MR angiography, and conventional angiography. Radiology 195: 445–449 (1995).PubMedGoogle Scholar
  32. [32]
    Kirchgeorg MA, Prokop M: Increasing spiral CT benefits with postprocessing applications. Eur J Radiol 28: 39–54 (1998).PubMedCrossRefGoogle Scholar
  33. [33]
    Kuszyk BS, Fishman EK: Technical aspects of CT angiography. Semin Ultrasound CT MR 19: 383–393 (1998).PubMedCrossRefGoogle Scholar
  34. [34]
    Johnson PT, Heath DG, Bliss DF et al.: Three-dimensional CT: real-time interactive volume rendering. AJR 167: 581–583 (1996).PubMedGoogle Scholar
  35. [35]
    Josephson SA, Bryant SO, Mak HK et al.: Evaluation of carotid stenosis using CT angiography in the initial evaluation of stroke and TIA. Neurology 63: 457–460 (2004).PubMedGoogle Scholar
  36. [36]
    Lawrence JA, Kim D, Kent KC et al.: Lower extremity spiral CT angiography versus catheter angiography. Radiology 194: 903–908 (1995).PubMedGoogle Scholar
  37. [37]
    Leclerc X, Godefroy O, Lucas C et al.: Internal carotid arterial stenosis: CT angiography with volume rendering. Radiology 210: 673–682 (1999).PubMedGoogle Scholar
  38. [38]
    Leclerc X, Godefroy O, Pruvo JP et al.: Computed tomographic angiography for the evaluation of carotid artery stenosis. Stroke 26: 1577–1581 (1995).PubMedGoogle Scholar
  39. [39]
    Lell M, Wildberger JE, Heuschmid M, Flohr T, Stierstorfer K, Fellner FA et al.: CT-angiography of the carotid artery: First results with a novel 16-slice-spiral-CT scanner. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 174: 1165–1169 (2002).PubMedCrossRefGoogle Scholar
  40. [40]
    Liu Y, Hopper KD, Mauger DT et al.: CT angiographic measurement of the carotid artery: optimizing visualization by manipulating window and level settings and contrast material attenuation. Radiology 217: 494–500 (2000).PubMedGoogle Scholar
  41. [41]
    Magarelli N, Scarabino T, Simeone AL et al.: Carotid stenosis: a comparison between MR and spiral CT angiography. Neuroradiology 40: 367–373 (1998).PubMedCrossRefGoogle Scholar
  42. [42]
    McCarthy MJ, Loftus IM, Thompson MM et al.: Angiogenesis and the atherosclerotic carotid plaque: an association between symptomatology and plaque morphology. J Vasc Surg 30: 261–268 (1999).PubMedCrossRefGoogle Scholar
  43. [43]
    Mayberg MR, Wilson SE, Yatsu F et al.: Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis. Veterans Affairs Cooperative Studies Program 309 Trialist Group. JAMA 266: 3289–3294 (1991).PubMedCrossRefGoogle Scholar
  44. [44]
    Milei J, Parodi JC, Ferreira M et al.: Atherosclerotic plaque rupture and intraplaque hemorrhage do not correlate with symptoms in carotid artery stenosis. J Vasc Surg 38: 1241–1247 (2003).PubMedCrossRefGoogle Scholar
  45. [45]
    Moll R, Dinkel HP: Value of the CT angiography in the diagnosis of common carotid artery bifurcation disease: CT angiography versus digital subtraction angiography and color flow Doppler. Eur J Radiol 39: 155–162 (2001).PubMedCrossRefGoogle Scholar
  46. [46]
    Napel S, Rubin GD, Jeffrey RB Jr.: STS-MIP: a new reconstruction technique for CT of the chest. J Comput Assist Tomogr 17: 832–838 (1993).PubMedCrossRefGoogle Scholar
  47. [47]
    Napel S, Marks MP, Rubin GD et al.: CT angiography with spiral CT and maximum intensity projection. Radiology 185: 607–610 (1992).PubMedGoogle Scholar
  48. [48]
    NASCET: Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 325: 445–453 (1991).CrossRefGoogle Scholar
  49. [49]
    Nicolaides A, Sabetai M, Kakkos SK et al.: The Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) study. Aims and results of quality control. Int Angiol 22: 263–272 (2003).PubMedGoogle Scholar
  50. [50]
    Papp Z, Patel M, Ashtari M, Takahashi M, Goldstein J, Maguire W et al.: Carotid artery stenosis: optimization of CT angiography with a combination of shaded surface display and source images. AJNR 18: 759–763 (1997).PubMedGoogle Scholar
  51. [51]
    Polacin A, Kalender WA, Marchal G: Evaluation of section sensitivity profiles and image noise in spiral CT. Radiology 185: 29–35 (1992).PubMedGoogle Scholar
  52. [52]
    Prokop M: General principles of MDCT. Eur J Radiol 45: S4–S10 (2003).PubMedCrossRefGoogle Scholar
  53. [53]
    Prokop M, Galanski M: Spiral and multislice: computed tomography of the body. Stuttgart New York: Thieme (2003).Google Scholar
  54. [54]
    Prokop M, Engelke C: Vascular System: In: Spiral and Multislice Computed Tomography of the Body. (Prokop M, Galanski M, eds.) pp 844–851. Stuttgart, New York: Thieme (2003)Google Scholar
  55. [55]
    Prokop M: Multislice CT angiography. Eur J Radiol 36: 86–96 (2000).PubMedCrossRefGoogle Scholar
  56. [56]
    Prokop M, Shin HO, Schanz A: Schaefer-Prokop CM. Use of maximum intensity projections in CT angiography: a basic review. Radiographics 17: 433–451 (1997).PubMedGoogle Scholar
  57. [57]
    Randoux B, Marro B, Koskas F et al.: Carotid artery stenosis: prospective comparison of CT, three-dimensional gadolinium-enhanced MR, and conventional angiography. Radiology 220: 179–185 (2001).PubMedGoogle Scholar
  58. [58]
    Remy-Jardin M, Remy J, Artaud D et al.: Peripheral pulmonary arteries: optimization of the spiral CT acquisition protocol. Radiology 204: 157–163 (1997).PubMedGoogle Scholar
  59. [59]
    Rubin GD: Techniques for performing multidetectorrow computed tomographic angiography. Tech Vasc Interv Radiol 4: 2–14 (2001).PubMedCrossRefGoogle Scholar
  60. [60]
    Rubin GD, Beaulieu CF, Argiro V, Ringl H, Norbash AM, Feller JF et al.: Perspective volume rendering of CT and MR images: applications for endoscopic imaging. Radiology 199: 321–330 (1996).PubMedGoogle Scholar
  61. [61]
    Rubin GD, Shiau MC, Schmidt AJ, Fleischmann D, Logan L, Leung AN et al.: Computed tomographic angiography: historical perspective and new state-of-the-art using multi detector-row helical computed tomography. J Comput Assist Tomogr 23: S83–S90 (1999).PubMedGoogle Scholar
  62. [62]
    Rubin GD, Dake MD, Napel S et al.: Spiral CT of renal artery stenosis: comparison of three-dimensional rendering techniques. Radiology 190: 181–189 (1994).PubMedGoogle Scholar
  63. [63]
    Rubin GD, Dake MD, Napel SA et al.: Three-dimensional spiral CT angiography of the abdomen: initial clinical experience. Radiology 186: 147–152 (1993).PubMedGoogle Scholar
  64. [64]
    Rydberg J, Buckwalter KA, Caldemeyer KS et al.: Multisection CT: scanning techniques and clinical applications. Radiographics 20: 1787–1806 (2000).PubMedGoogle Scholar
  65. [65]
    Sameshima T, Futami S, Morita Y et al.: Clinical usefulness of and problems with three-dimensional CT angiography for the evaluation of arteriosclerotic stenosis of the carotid artery: comparison with conventional angiography, MRA, and ultrasound sonography. Surg Neurol 51: 301–308; discussion 308–309 (1999).PubMedCrossRefGoogle Scholar
  66. [66]
    Sato Y, Shiraga N, Nakajima S et al.: Local maximum intensity projection (LMIP): a new rendering method for vascular visualization. J Comput Assist Tomogr 22: 912–917 (1998).PubMedCrossRefGoogle Scholar
  67. [67]
    Schwartz RB: Helical (spiral) CT in neuroradiologic diagnosis. Radiol Clin North Am 33: 981–995 (1995).PubMedGoogle Scholar
  68. [68]
    Schwartz RB, Jones KM, Chernoff DM et al.: Common carotid artery bifurcation: evaluation with spiral CT. Work in progress. Radiology 185: 513–519 (1992).PubMedGoogle Scholar
  69. [69]
    Stehling MK, Rosen MP, Weintraub J et al.: Spiral CT venography of the lower extremity. AJR 163: 451–453 (1994).PubMedGoogle Scholar
  70. [70]
    Stehling MK, Lawrence JA, Weintraub JL et al.: CT angiography: expanded clinical applications. AJR 163: 947–955 (1994).PubMedGoogle Scholar
  71. [71]
    Suzuki S, Furui S, Kaminaga T et al.: Measurement of vascular diameter in vitro by automated software for CT angiography: effects of inner diameter, density of contrast medium, and convolution kernel. AJR 182: 1313–1317 (2004).PubMedGoogle Scholar
  72. [72]
    Thomsen HS, Morcos SK: In which patients should serum creatinine be measured before iodinated contrast medium administration? Eur Radiol 15: 749–754 Epub 2004 Dec 31 (2005).PubMedCrossRefGoogle Scholar
  73. [73]
    Tippins RB, Torres WE, Baumgartner BR et al.: Are screening serum creatinine levels necessary prior to outpatient CT examinations? Radiology 216: 481–484 43(2000).PubMedGoogle Scholar
  74. [74]
    van Hoe L, Marchal G, Baert AL et al.: Determination of scan delay time in spiral CT-angiography: utility of a test bolus injection. J Comput Assist Tomogr 19: 216–220 (1995).PubMedCrossRefGoogle Scholar
  75. [75]
    Van Ooijen PM, Ho KY, Dorgelo J et al.: Coronary Artery Imaging with Multidetector CT: Visualization Issues. Radiographics 7: 7 (2003).Google Scholar
  76. [76]
    Verhoek G, Costello P, Khoo EW, Wu R, Kat E, Fitridge RA: Carotid bifurcation CT angiography: assessment of interactive volume rendering. J Comput Assist Tomogr 23: 590–596 (1999).PubMedCrossRefGoogle Scholar
  77. [77]
    Villablanca JP, Jahan R, Hooshi P et al.: Detection and characterization of very small cerebral aneurysms by using 2D and 3D helical CT angiography. AJNR 23: 1187–1198 (2002).PubMedGoogle Scholar
  78. [78]
    Wang G, Vannier MW: Maximum volume coverage in spiral computed tomography scanning. Acad Radiol 3: 423–428 (1996).PubMedCrossRefGoogle Scholar
  79. [79]
    Weidekamm C: Low kVp settings improve contrast enhancement and reduce radiation exposure in spiral CT of pulmonary emboli. In: Baert AL (ed.) ECR; p. 149. Wien Austria: Springer (2002).Google Scholar
  80. [80]
    Zhang Z, Berg M, Ikonen A et al.: Carotid stenosis degree in CT angiography: assessment based on luminal area versus luminal diameter measurements. Eur Radiol 14 (2005).Google Scholar
  81. [81]
    Zhang Z, Berg MH, Ikonen AE et al.: Carotid artery stenosis: reproducibility of automated 3D CT angiography analysis method. Eur Radiol 14: 665–672 (2003).PubMedCrossRefGoogle Scholar

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© Springer-Verlag/Wien 2007

Authors and Affiliations

  • M. Berg
    • 1
  • R. Vanninen
    • 1
  • H. Manninen
    • 1
  1. 1.Department of Clinical RadiologyKuopio University HospitalKuopioFinland

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