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Computed Tomography Angiography and Magnetic Resonance Angiography of the Carotids

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Noninvasive Vascular Diagnosis

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Abstract

The imaging modalities most often used to evaluate patients for cervical carotid stenosis are carotid duplex ultrasound, computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA).

Duplex ultrasonography provides an accurate noninvasive tool to determine the degree of carotid stenosis and plaque morphology in most patients. It is usually the initial study in patients who present with a carotid bruit or carotid symptoms. This study is highly dependent on technique.

Meanwhile, CTA has recently been regarded as a valuable test for carotid artery stenosis. It is possible to obtain three-dimensional images of the carotid arteries by CTA, although this requires a specialized workstation and dedicated personnel for data processing. CTA cannot be used to evaluate flow dynamics and as such cannot be used for the diagnosis of subclavian steal or other flow-based lesions. The test is easy to perform and associated with few risks. Arterial access is not required, and there is no associated risk of stroke. The image quality rivals that of DSA when the examination is performed on a high-quality helical scanner and reformatted to three-dimensional images by well-trained personnel. CTA can provide additional information about the conformation and composition of the plaque.

CTA is less susceptible than MRA to overestimating the severity of carotid stenosis. It is extremely fast and offers submillimeter spatial resolution, is less expensive than contrast-enhanced MRA, and has the ability to visualize soft tissue, bone, and blood vessels at the same time. CTA can interrogate the arterial tree from the aortic arch to the circle of Willis.

MRA has the advantage of being noninvasive, does not require iodinated contrast or ­ionizing radiation, and provides unlimited number of projections of the carotid lumen from a single acquisition.

Contrast-enhanced MRA used MR technique to provide flow-independent anatomic information. The technique is somewhat similar to CTA with first-pass MRA. Because these images are not dependent on flow, they provide a more accurate assessment of stenosis and visualization of ulcerated plaques.

Additionally, information about the cerebral circulation can be obtained simultaneously, including patency of the carotid siphon and middle cerebral artery. MRA can also assess intrathoracic and intracranial lesions that are not amenable to duplex interrogation. Using dedicated protocols, MRA can also demonstrate specific plaque components, e.g., calcium, lipid, fibrocellular element, or thrombus within the plaques. The ability to use MRA as a diagnostic tool for carotid stenosis is sadly often dependent on local expertise and familiarity with the test.

This chapter summarizes the role of each imaging modality in the diagnosis of carotid artery disease.

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Author information

Authors and Affiliations

  1. Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, 3110 MacCorkle Ave SE, Charleston, WV, 25304, USA

    Ali F. AbuRahma M.D., RVT, RPVI

  2. Charleston Area Medical Center, Charleston, WV, USA

    Ali F. AbuRahma M.D., RVT, RPVI

  3. Section of Vascular Surgery and Endovascular Therapy, The University of Chicago, 5841 S. Maryland Ave., MC 5028, Chicago, IL, 60637, USA

    Hisham Bassiouny M.D., FACS

Authors
  1. Ali F. AbuRahma M.D., RVT, RPVI
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  2. Hisham Bassiouny M.D., FACS
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Editors and Affiliations

  1. Robert C. Byrd Health Sciences Center, Dept. Surgery, West Virginia University, MacCorkle Ave. SE 3100, Charleston, 25304, West Virginia, USA

    Ali F. AbuRahma

  2. , Interventional Cardiology, UC San Diego Sulpizio Cardiovascular Cen, 9300 Campus Point Drive 7784, La Jolla, 92037, California, USA

    Dennis F. Bandyk

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AbuRahma, A.F., Bassiouny, H. (2013). Computed Tomography Angiography and Magnetic Resonance Angiography of the Carotids. In: AbuRahma, A., Bandyk, D. (eds) Noninvasive Vascular Diagnosis. Springer, London. https://doi.org/10.1007/978-1-4471-4005-4_15

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  • DOI: https://doi.org/10.1007/978-1-4471-4005-4_15

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  • Print ISBN: 978-1-4471-4004-7

  • Online ISBN: 978-1-4471-4005-4

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