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Angiographic correlation of CT calcification in the carotid siphon
R J Woodcock1, J H Goldstein, D F Kallmes
1Department of Radiology, University of Virginia Charlottesville 22908, USA.
Insights
Severe carotid siphon calcification on bone window CT scans accurately predicts significant stenosis. This noninvasive method aids in managing patients with carotid bifurcation stenosis.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Coronary artery calcification is linked to significant stenosis.
- Carotid siphon calcification's predictive value for stenosis is not well-established.
- Carotid siphon stenosis impacts management of ipsilateral carotid bifurcation stenosis.
Purpose of the Study:
- Determine optimal parameters for carotid siphon calcification assessment on head CT scans.
- Compare CT findings with angiographic results for carotid siphon stenosis.
Main Methods:
- Retrospective review of 64 patients (128 vessels) with head CT and carotid arteriography.
- Characterization of carotid siphon calcification on CT (brain and bone windows) as mild, moderate, or severe.
- Comparison of CT findings with angiographic stenosis.
Main Results:
- Bone windows: 86% sensitivity, 98% specificity for >50% stenosis.
- Brain windows: 100% sensitivity, 0% specificity for >50% stenosis.
- Severe calcification on bone windows had 86% PPV for >50% stenosis.
Conclusions:
- Severe carotid siphon calcification on bone window CT correlates with >50% angiographic stenosis.
- CT identification of severe calcification offers a potential noninvasive method for detecting carotid siphon stenosis.
- This finding is crucial for managing patients with carotid bifurcation stenosis.
Background And Purpose:
Calcification in the coronary arteries has been correlated with significant vessel stenosis. The predictive value of calcification within the carotid siphon has not been characterized; however, stenosis in the carotid siphon is potentially important in determining management of patients with ipsilateral carotid bifurcation stenosis. The purpose of this study was to determine optimal parameters for assessing carotid siphon calcification on head CT scans and to compare the CT findings with angiographic results.
Methods:
We performed a retrospective review of patients referred for diagnostic carotid arteriography. Those patients who also had undergone a head CT study at our institution were selected. The CT scans and angiograms of 64 patients (128 vessels) were reviewed. Carotid siphon calcification on CT scans was characterized on brain and bone windows as mild, moderate, or severe. Comparison was then made with angiographic findings.
Results:
The sensitivity and specificity of CT for depicting greater than 50% angiographic stenosis in the carotid siphon were 86% and 98%, respectively, for bone windows and 100% and 0%, respectively, for brain windows. The positive predictive value (PPV) for a stenosis of greater than 50% as evidenced by severe calcification was 86% on bone windows and 11% on brain windows. The PPV for mild and moderate calcification on bone windows was 2.5% and 0%, respectively.
Conclusion:
Severe CT calcification in the carotid siphon as characterized on bone windows correlates with a carotid siphon stenosis of greater than 50% as determined angiographically. Therefore, the identification of severe calcification offers a potential noninvasive method for identifying stenosis of the carotid siphon. This information may be essential in determining management and prognosis for patients with carotid bifurcation stenosis.