Time-Resolved 4-Dimensional Computed-Tomography Angiography Can Correctly Identify Carotid Pseudo-Occlusion

Area of Science:

• Vascular Surgery
• Diagnostic Imaging
• Radiology

Background:

• Accurate diagnosis of internal carotid artery (ICA) stenosis is crucial for patient selection for carotid endarterectomy.
• Carotid pseudo-occlusion, a flow-related artifact, can be misdiagnosed as total ICA occlusion on noninvasive imaging.
• Misdiagnosis can lead to eligible patients being denied necessary surgical intervention.

Observation:

• A case study of an 82-year-old male with symptomatic critical ICA stenosis is presented.
• Conventional imaging modalities including single-phase CT angiography, MR angiography, and Doppler ultrasonography suggested apparent occlusion.
• Time-resolved 4D CT angiography was utilized for diagnosis.

Findings:

• Time-resolved 4D CT angiography successfully identified symptomatic high-grade internal carotid artery stenosis.
• The study highlights the ability of 4D CT angiography to differentiate true occlusion from pseudo-occlusion.
• This advanced imaging technique provided a correct diagnosis where other methods failed.

Implications:

• This case demonstrates the potential of 4D CT angiography in diagnosing carotid pseudo-occlusion.
• Accurate diagnosis can prevent inappropriate denial of surgical treatment for eligible patients.
• Early and correct identification of ICA stenosis improves patient outcomes and surgical decision-making.