Multidetector-row computed tomography in evaluation of atherosclerotic carotid plaques complicated with intraplaque
Marko Ajduk1, Ladislav Pavić, Stela Bulimbasić
1Department of Vascular Surgery, University Hospital Dubrava, Zagreb, Croatia. majduk@yahoo.com
Insights
Multidetector-row computed tomography (CT) shows high sensitivity but moderate specificity in detecting intraplaque hemorrhage within atherosclerotic carotid plaques. This imaging technique aids in identifying complicated carotid artery stenosis.
Area of Science:
- Vascular Medicine
- Radiology
- Pathology
Background:
- Atherosclerotic carotid plaques can develop intraplaque hemorrhage, a complication associated with increased stroke risk.
- Accurate detection of intraplaque hemorrhage is crucial for risk stratification and treatment decisions in carotid artery stenosis.
Purpose of the Study:
- To evaluate the sensitivity and specificity of multidetector-row computed tomography (CT) for detecting intraplaque hemorrhage in atherosclerotic carotid plaques.
- To compare CT findings with histological analysis of surgically removed carotid plaques.
Main Methods:
- Multidetector-row CT was performed preoperatively on 31 patients undergoing surgery for carotid artery stenosis.
- Carotid plaques were analyzed histologically using the American Heart Association classification.
- CT-derived tissue density (Hounsfield units) was compared between complicated (with hemorrhage) and uncomplicated plaques.
Main Results:
- Carotid plaques with intraplaque hemorrhage had a median tissue density of 22 HU, significantly lower than uncomplicated plaques (59 HU).
- Multidetector-row CT achieved 100% sensitivity and 64.7% specificity in detecting intraplaque hemorrhage, using a threshold of 31 HU.
- The highest observed tissue density for complicated plaques was 31 HU.
Conclusions:
- Multidetector-row CT demonstrates high sensitivity for detecting intraplaque hemorrhage in atherosclerotic carotid plaques.
- The specificity is moderate, suggesting potential for false positives, but the technique is valuable for identifying hemorrhage in carotid stenosis.
Abstract:
Our aim was to determine the sensitivity and specificity of multidetector-row computed tomography (CT) in detecting atherosclerotic carotid plaques complicated with intraplaque hemorrhage. We examined carotid plaques from 31 patients operated for carotid artery stenosis. Results of preoperative multidetector-row CT analysis of carotid plaques were compared with results of histological analysis of the same plaque areas. Carotid endarterectomy was performed within 1 week of multidetector-row CT. American Heart Association classification of atherosclerotic plaques was applied for histological classification. Median tissue density of carotid plaques complicated with intraplaque hemorrhage was 22 Hounsfield units (HU). Median tissue density of noncalcified segments of uncomplicated plaques was 59 HU (p=0.0062). The highest tissue density observed for complicated plaques was 31 HU. Multidetector-row CT detected plaques complicated with hemorrhage with sensitivity of 100% and specificity of 64.7%, with tissue density of 31 HU as a threshold value. Multidetector-row CT showed a high level of sensitivity and a moderate level of specificity in detecting atherosclerotic carotid plaques complicated with hemorrhage.
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