Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Internal Medicine Neurology Oncology Pediatrics Respiratory Medicine Surgery
Congress Coverage
2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting

Keynote Webinar | Spotlight on Diet and Diabetes

Watch on-demand

An expert-led symposium exploring the prevention and management of type 2 diabetes through dietary interventions. 
ADVANCED SEARCH
Log in
Top
European Radiology

Open Access 22-09-2023 | CT Angiography | Computed Tomography

A novel method of carotid artery wall imaging: black-blood CT

Authors: Yao Lu, Ruoyao Cao, Sheng Jiao, Ling Li, Chao Liu, Hailong Hu, Zhuangfei Ma, Yun Jiang, Juan Chen

Published in: European Radiology

Login to get access

Abstract

Objectives

To evaluate the application of black-blood CT (BBCT) in carotid artery wall imaging and its accuracy in disclosing stenosis rate and plaque burden of carotid artery.

Methods

A total of 110 patients underwent contrast-enhanced CT scan with two phases, and BBCT images were obtained using contrast-enhancement (CE)-boost technology. Two radiologists independently scored subjective image quality on black-blood computerized tomography (BBCT) images using a 4-point scale and then further analyzed plaque types. The artery stenosis rate on BBCT was measured and compared with CTA. The plaque burden on BBCT was compared with that on high-resolution intracranial vessel wall MR imaging (VW-MR imaging). The kappa value and intraclass correlation coefficient (ICC) were used for consistency analysis. The diagnostic accuracy of BBCT for stenosis rate and plaque burden greater than 50% was evaluated by AUC.

Results

The subjective image quality scores of BBCT had good consistency between the two readers (ICC = 0.836, p < 0.001). BBCT and CTA had a good consistency in the identification of stenosis rate (p < 0.001). There was good consistency between BBCT and VW-MR in diagnosis of plaque burden (p < 0.001). As for plaque burden over 50%, BBCT had good sensitivity (93.10%) and specificity (73.33%), with an AUC of 0.950 (95%CI 0.838–0.993). Compared with CTA, BBCT had higher consistency with VW-MR in disclosing low-density plaques and mixed plaques (ICC = 0.931 vs 0.858, p < 0.001).

Conclusions

BBCT can not only display the carotid artery wall clearly but also accurately diagnose the stenosis rate and plaque burden of carotid artery.

Clinical relevance statement

Black-blood CT, as a novel imaging technology, can assist clinicians and radiologists in better visualizing the structure of the vessel wall and plaques, especially for patients with contraindication to MRI.

Key Points

• Black-blood CT can clearly visualize the carotid artery wall and plaque burden.
• Black-blood CT is superior to conventional CTA with more accurate diagnosis of the carotid stenosis rate and plaque burden features.
Literature
1.
Saba L, Saam T, Jäger HR et al (2019) Imaging biomarkers of vulnerable carotid plaques for stroke risk prediction and their potential clinical implications. Lancet Neurol 18:559–572 CrossRefPubMed
2.
Brinjikji W, Huston J, Rabinstein AA, Kim G, Lerman A, Lanzino G (2016) Contemporary carotid imaging: from degree of stenosis to plaque vulnerability. J Neurosurg 124:27–42 CrossRefPubMed
3.
Abbott AL, Paraskevas KI, Kakkos SK et al (2015) Systematic review of guidelines for the management of asymptomatic and symptomatic carotid stenosis. Stroke 46:3288–3301 CrossRefPubMed
4.
Motoyama R, Saito K, Tonomura S et al (2019) Utility of complementary magnetic resonance plaque imaging and contrast-enhanced ultrasound to detect carotid vulnerable plaques. J Am Heart Assoc 8:e011302 CrossRefPubMedPubMedCentral
5.
Mac Grory B, Emmer BJ, Roosendaal SD, Zagzag D, Yaghi S, Nossek E (2020) Carotid web: an occult mechanism of embolic stroke. J Neurol Neurosurg Psychiatry 91:1283–1289 CrossRefPubMed
6.
Saba L, Antignani PL, Gupta A et al (2022) International Union of Angiology (IUA) consensus paper on imaging strategies in atherosclerotic carotid artery imaging: from basic strategies to advanced approaches. Atherosclerosis 354:23–40 CrossRefPubMed
7.
Saloner D, Acevedo-Bolton G, Wintermark M, Rapp JH (2007) MRI of geometric and compositional features of vulnerable carotid plaque. Stroke 38:637–641 CrossRefPubMed
8.
Jungmann PM, Agten CA, Pfirrmann CW, Sutter R (2017) Advances in MRI around metal. J Magn Reson Imaging 46:972–991 CrossRefPubMed
9.
Baerends E, Oostveen LJ, Smit CT et al (2018) Comparing dual energy CT and subtraction CT on a phantom: which one provides the best contrast in iodine maps for sub-centimetre details? Eur Radiol 28:5051–5059 CrossRefPubMedPubMedCentral
10.
Xu J, Wang S, Wang X et al (2022) Effects of contrast enhancement boost postprocessing technique in combination with different reconstruction algorithms on the image quality of abdominal CT angiography. Eur J Radiol 154:110388 CrossRefPubMed
11.
Horie N, Morikawa M, Ishizaka S et al (2012) Assessment of carotid plaque stability based on the dynamic enhancement pattern in plaque components with multidetector CT angiography. Stroke 43:393–398 CrossRefPubMed
12.
Warlow C (1991) MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis. Lancet 337:1235–1243 CrossRef
13.
Brunner G, Virani SS, Sun W et al (2020) Associations between carotid artery plaque burden, plaque characteristics, and cardiovascular events. Jama Cardiol 6:1–8 PubMedCentral
14.
Lyu J, Ma N, Tian C et al (2019) Perfusion and plaque evaluation to predict recurrent stroke in symptomatic middle cerebral artery stenosis. Stroke Vasc Neurol 4:129–134 CrossRefPubMedPubMedCentral
15.
Grob DJM, Smit EJ, Prince JL et al (2019) Iodine maps from subtraction CT or dual-energy CT to detect pulmonary emboli with ct angiography: a multiple-observer study. Radiology 292:197–205 CrossRefPubMed
16.
Chen GZ, Luo S, Zhou CS, Zhang LJ, Lu GM (2017) Digital subtraction CT angiography for the detection of posterior inferior cerebellar artery aneurysms: comparison with digital subtraction angiography. Eur Radiol 27:3744–3751 CrossRefPubMed
17.
Treitl KM, Maurus S, Sommer NN et al (2017) 3D-black-blood 3T-MRI for the diagnosis of thoracic large vessel vasculitis: a feasibility study. Eur Radiol 27:2119–2128 CrossRefPubMed
18.
Luo Y, Guo Z, Niu P et al (2016) 3D T1-weighted black blood sequence at 3.0 Tesla for the diagnosis of cervical artery dissection. Stroke Vasc Neurol 1:140–146
19.
Henningsson M, Malik S, Botnar R, Castellanos D, Hussain T, Leiner T (2022) Black-blood contrast in cardiovascular MRI. J Magn Reson Imaging 55:61–80 CrossRefPubMed
20.
Rowe SP, Chu LC, Recht HS, Lin CT, Fishman EK (2020) Black-blood cinematic rendering: a new method for cardiac CT intraluminal visualization. J Cardiovasc Comput Tomogr 14:272–274 CrossRefPubMed
21.
Rotzinger DC, Si-Mohamed SA, Shapira N, Douek PC, Meuli RA, Boussel L (2020) “Dark-blood” dual-energy computed tomography angiography for thoracic aortic wall imaging. Eur Radiol 30:425–431 CrossRefPubMed
22.
Josephson SA, Bryant SO, Mak HK, Johnston SC, Dillon WP, Smith WS (2004) Evaluation of carotid stenosis using CT angiography in the initial evaluation of stroke and TIA. Neurology 63:457–460 CrossRefPubMed
23.
Wendorff C, Wendorff H, Pelisek J et al (2015) Carotid plaque morphology is significantly associated with sex, age, and history of neurological symptoms. Stroke 46:3213–3219 CrossRefPubMed
24.
25.
Cai J, Hatsukami TS, Ferguson MS et al (2005) In vivo quantitative measurement of intact fibrous cap and lipid-rich necrotic core size in atherosclerotic carotid plaque. Circulation 112:3437–3444 CrossRefPubMed
26.
Kalra MK, Homayounieh F, Arru C, Holmberg O, Vassileva J (2020) Chest CT practice and protocols for COVID-19 from radiation dose management perspective. Eur Radiol 30:6554–6560 CrossRefPubMedPubMedCentral
27.
Ohno Y, Koyama H, Seki S, Kishida Y, Yoshikawa T (2019) Radiation dose reduction techniques for chest CT: principles and clinical results. Eur J Radiol 111:93–103 CrossRefPubMed
Metadata
Title
A novel method of carotid artery wall imaging: black-blood CT
Authors
Yao Lu
Ruoyao Cao
Sheng Jiao
Ling Li
Chao Liu
Hailong Hu
Zhuangfei Ma
Yun Jiang
Juan Chen
Publication date
22-09-2023
Publisher
Springer Berlin Heidelberg
Published in
European Radiology
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-023-10247-5