Carotid artery stenosis: Prospective comparison of CT, three-dimensional gadolinium-enhanced MR, and conventional angiography

PURPOSE: To prospectively compare gadolinium-enhanced magnetic resonance (M R) angiography and computed tomographic (CT) angiography with digital subtr action angiography (DSA) for use in detecting atheromatous stenosis and pla que morphology at the carotid bifurcation. MATERIALS AND METHODS: Forty-four carotid arteries (in 22 patients) were an alyzed by using CT angiography, enhanced MR angiography, and DSA. CT and en hanced MR angiograms were reconstructed with maximum intensity projection a nd multiplanar volume reconstruction. The following four features were anal yzed: degree of stenosis on the basis of North American Symptomatic Carotid Endarterectomy Trial criteria, length of stenosis, luminal surface, and pr esence of ulcers. RESULTS: There was significant correlation between CT angiography, enhanced MR angiography, and DSA for degree and length of stenosis. With enhanced M R angiography and CT angiography, degree of stenosis was underestimated in two of 44 cases. No case of overestimation with CT angiography was found. S evere internal carotid artery stenoses were detected with high sensitivity and specificity: 100% and 100%, respectively, with CT angiography; 93% and 100%, respectively, with enhanced MR angiography. Luminal surface irregular ities were most frequently seen at CT angiography. With CT angiography and enhanced MR angiography, more ulceration was detected than with DSA. CONCLUSION: There was a significant correlation between CT angiography, enh anced MR angiography, and DSA in evaluation of carotid artery stenosis. Enh anced MR angiography or CT angiography can be used to adequately evaluate c arotid stenosis.