Correlation between morphologic carotid plaque findings based on color-Doppler and CT multidetector angiography with intraopertive findings in carotid artery stenosis

Abstract

Bacground/Aim. Vast majority of patients with corotid artery sclerosis do not have transitory ischemic attacks (TIA) as working to the persistent silent disease, but stroke is the first sign. Precise and early diagnosis of the carotid artery disease and plaques are very important. The aim of this study was to determine how the composition / identity of diagnostic methods, color-Doppler, ultrasonography (US) CT multidetector angio (MDCTA) scan and intraoperative (IO) findings, as well as the morphology of plaques in patients with haemodynamic significant stenosis of the internal carotid artery. Methods. Carotid plaques were observed by two diagnostic methods, US and MDCTA, and these findings were correlated with the IO findings. Results. In 62 patients both carotid artheries were examined and 83 plaques were observed. There were 68 surgical interventions. The structure of plaques was divided into four types: lipid, fibrous, fibrocalcified and calcified plaque. US showed: lipid plaques 10.8%; fibrous 1.2%; fibrocalcified 44.6% and calcified 43.4%, and the MDCTA lipid plaques 8.4%; fibrocalcified 48.2% and calcified 43.4%. Intraoperative findings were: lipid plaques 10.3%; fibrocalcified 41.2% and calcified 48.5%. A statistically highly significant agreement between the US and MDCTA in the diagnosis of plaque morphology was obtained (Cramer's V = 0.919, p < 0.01; Lambda = 0.921, p < 0.01) and also statistically significant agreement between US and IO findings (Cramer' s V = 0.831, p < 0.01; Lambda = 0.859, p < 0.01). A statistically highly significant agreement between MDCTA and IO findings in plaque morphology was found, as well (Cramer's V = 0.815, p < 0.01; Lambda = 0.829, p < 0.01). Conclusion. There is statistically highly significant correlation between US and MDCTA diagnostic methods in the evaluation of plaque morphology in surgically significant stenosis of internal carotid artery as well as their agreement with the intraoperative finding.Uvod/Cilj. Veliki broj bolesnika sa arteriosklerozom kardotidnih arterija nema tranzitorne ishemijske atake (TIA) koji bi upozorili na postojecu asimptomatsku bolest, a rezultira mozdanim udarom. Zbog toga precizna i blagovremena dijagnostika oboljenja karotidnih arterija i otkrivanje plakova izuzetno su znacajni. Cilj rada bio je utvrditi slaganje/ podudarnost dijagnostickih metoda, kolor doplera i multidetektorske kompjuterizovane tomografije (MDCT) sa intraoperativnim (IO) nalazom pri odredjivanju morfologije plaka kod bolesnika sa hemodinamski/hirurski znacajnim stenozama na unutrasnjoj karotidnoj arteriji. Metode. Posle neuroloskog pregleda bolesnika sa TIA, mozdanim insultom ili nekom drugom simptomatologijom, ucinjeni su ultrasonografski pregledi karotidnih arterija. Bolesnici kod kojih su uoceni plakovi koji cine hemodinamski/hirurski znacajne stenoze prema North American Symptomatic Corotid Endarterectomy Trial (NASCET) kriterijumu (70-99%) posmatrani su dvema dijagnostickim metodama: ultrazvukom (UZ) MDCT-a, a dobijeni nalazi morfologije plaka uporedjeni su sa IO nalazom hirurga. Rezultati. Posmatrane su 124 karotidne arterije kod 62 bolesnika, uocena su 83 plaka i izvrseno je 68 hirurskih intervencija. Plakovi na unutrasnjoj karotidnoj arteriji prema strukturi podeljeni su u cetiri kategorije: lipidni, fibrozni, fibrokalcifikovani i kalcifikovani. Ultrazvucnim pregledom vidjeno je 9 (10,8%) lipidnih plakova; 1 (1,2%) fibrozni; 3 (44,6%) fibrokalcifikovana i 36 (43,4%) kalcifikovanih; MDCT-om: 7 (8,4%) lipidnih; 0 (0%) fibroznih; 40 (48,2%) fibrokalcifikovanih i 36 (43,4%) kalcifikovanih; intraoperativno nadjeno je: 7 (10,3%) fibroznih; 28 (41,2%) fibrokalcifikovanih i 33 (48,5%) kalcifikovana plaka. Utvrdjeno je statisticki visokoznacajno slaganje UZ/MDCT dijagnostike morfologije plaka (Cramer's V = 0,919; p < 0,01), statisticki visokoznacajno slaganje UZ/IO nalaza morfologije plaka (Cramer's V = 0,831; p < 0,01) i statisticki visoko znacajno slaganje MDCT/IO nalaza morfologije plaka (Cramer's V = 0,815; p < 0,01). Zakljucak. Postoji statisticki visokoznacajno slaganje dve dijagnosticke metode (UZ i MDCT) u proceni morfologije plaka kod hemodinamski- znacajnih stenoza unutrasnje karotidne arterije., kao i statisticki visokoznacajno slaganje ove dve dijagnosticke metode sa intraoperativnim nalazom hirurga.