Three-dimensional reconstructions of carotid bifurcation from CT images: evaluation of different rendering methods

Three-dimensional computed tomographic angiography (3D-CTA) and digital subtraction angiography of the cervical carotid artery were performed bilaterally in 15 patients with suspected stenoses. A new semi-automatic segmentation and new rendering methods were used. The degree of stenosis of internal carotid arteries, as determined both by axial slices and 3D images (surface, integral, maximum-intensity-projection, and raysum-rendered images), was compared qualitatively and quantitatively to angiographic findings. In correlation to angiography, the accuracy in determining the stenosis classification of internal carotid arteries was of 97% for axial slices and 59-90% for 3D images, respectively. Raysum (pseudoradiograph) rendering was found to be the most reliable rendering method and gave the most similar results to angiography. The accuracy of all rendering methods was improved by applying calcification removing algorithm, with a statistically significant difference between surface rendering without plaque removal and raysum rendering using the removing algorithm.