NONINVASIVE ASSESSMENT OF NECK-VESSEL PATHOLOGY

Clinical trials (NASCET, ECTS) have ,;shown that carotid endarterectom y is protective :against stroke in patients with symptomatic severe ca rotid stenosis. To decrease costs and risks, new diagnostic tools have been developed, such as duplex ultrasound (DUS), magnetic resonance a ngiography (MRA), and more recently computed tomography angiography (C TA). CTA and MRA provide excellent 3D angiography images of the extrac ranial vessels, using a volume-rendering technique. Digitally subtract ed MRA (DSA-MRA) obtained with high-speed acquisitions during gadolini um injection has also recently become available. These techniques are changing the role of non-invasive assessment of carotid stenosis. Alth ough it is probably too early to assess a definite diagnostic algorith m, the use of DSA as a pre-surgical tool for defining carotid stenosis is rapidly decreasing.