Color doppler ultrasonography and multislice computer tomography angiography in carotid plaque detection and characterization

Abstract

Beckground/Aim. Cerebrovascular diseases are the third leading cause of mortality in the world, following malignant and cardiovascular diseases. Therefore, their timely and precise diagnostics is of great importance. The aim of this study was to compare duplex scan Color Doppler ultrasonography (CDU) with multislice computed tomography angiography (MSCTA) in detection of morphological and functional disorders at extracranial level of carotid arteries. Methods. The study included 75 patients with 150 carotid arteries examined in the period from January 2008 to April 2009. The patients were firstly examined by CDU, then MSCTA, followed by the surgery of extracranial segment of carotid arteries. In 10 patients, the obtained material was referred for histopathological (HP) examination. We used both CDU and MSCT in the analysis of: plaque surface, plaque structure, degree of stenosis, and the presence of intraplaque hemorrhage. Results. The results obtained by CDU and MSCTA were first compared between themselves, and then to intraoperative findings. Retrospective analysis showed that MSCTA is more sensitive than CDU in assessment of plaque surface (for smooth plaques CDU 89% : MSCTA 97%; for plaques with irregular surface CDU 75% : MSCTA 87%; for ulcerations CDU 54% : MSCTA 87%). Regarding determination of plaque structure (mixed plaque CDU 66% : MSCTA 70%; correlation with HP findings CDU 94% : MSCTA 96%) and localization (CDU 63% : MSCTA 65%), and in terms of sensitivity and specificity, both methods showed almost the same results. Also, there is no statistical difference between these two methods for the degree of stenosis (CDU 96% : MSCTA 98%). Conclusion. Atherosclerotic disease of extracranial part of carotid arteries primarily affects population of middle-aged and elderly, showing more associated risk factors. Sensitivity and specificity of CDU and MSCTA regarding plaque composition, the degree of stenosis and plaque localization are almost the same. These results and the fact that there are no adverse effects (high radiation dose) compared to MSCTA indicate that CDU should be the initial method in diagnostic algorythm for carotid arteries.Uvod/Cilj. Cerebrovaskularne bolesti posle malignih i kardiovaskularnih oboljenja najcesci su uzrok mortaliteta u svetu. Zbog toga, pravovremena i tacna dijagnostika oboljenja na ekstrakranijalnom segmentu karotidnih arterija, kao jednog od osnovnih cinilaca u nastanku cerebrovaskularnih bolesti, od velikog je znacaja. Cilj ove studije bio je da se uporede rezultati kolor dopler ultrasonografije (CDU) i viseslojne kompjuterizovane tomografske angiografije (MSCTA) u odredjivanju postojanja morfoloskih i funkcionalnih poremecaja na ekstrakranijalnom segmentu karotidnih arterija. Metode. Studija je obuhvatala 75 bolesnika kod kojih je pregledano 150 karotidnih arterija, od januara 2008. do aprila 2009. Bolesnicima je prvo uradjen CDU i MSCTA, a zatim operacija karotidnih arterija. Kod 10 bolesnika uzet je materijal za patohistolosku (PH) analizu. Analizirani su sledeci parametri : povrsina plaka, sastav plaka, stepen stenoze ekstrakranijalnog dela karotidne arterije i postojanje intraplakalne hemoragije. Rezultati. Rezultati CDU i MSCTA uporedjeni su medjusobno, a zatim i sa intraoperativnim nalazom. Utvrdjeno je da je MSCTA senzitivnija nego CDU u vizulizaciji povrsine plaka (kod glatkih plakova CDU 89% : MSCTA 97%; kod plakova neravne povrsine CDU 75% : MSCTA 87%; kod ulkusa CDU 54% : MSCTA 87%). U odnosu na sastav plaka MSCTA je senzitivnija u odnosu na CDU (mesoviti plak CDU 66% : MSCTA 70%; korelacija sa PH nalazom CDU 94% : MSCTA 96%), dok su u odnosu na lokalizaciju plaka (CDU 63% : MSCTA 65%) senzitivnost i specificnost obe metode priblizno isti. Ne postoji statisticki znacajna razlika izmedju metoda u odnosu na postojanje stepena stenoze ekstrakranijalnog dela karotidne arterije (CDU 96% : MSCTA 98%). Zakljucak. Aterosklerotska bolest karotidnih arterija javlja se kod bolesnika srednjeg i starijeg zivotnog doba, cesto udruzena sa faktorima rizika. Senzitivnost i specificnost CDU i MSCTA u proceni sastava plaka, stepena stenoze i lokalizacije plaka karotidnih arterija priblizno je ista. Zbog dobijenih rezultata i cinjenice da nema stetnog efekta (visoke doze zracenja) u odnosu na MSCTA, CDU treba da predstavlja inicijalnu metodu u dijagnostickom algoritmu karotidnih arterija.