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Insights into Imaging
Published in: Insights into Imaging 4/2018

Open Access 01-08-2018 | Original Article

Grading of carotid artery stenosis with computed tomography angiography: whether to use the narrowest diameter or the cross-sectional area

Authors: Kristina Samarzija, Petar Milosevic, Zoran Jurjevic, Emilija Erdeljac

Published in: Insights into Imaging | Issue 4/2018

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Abstract

Objectives

To compare the estimation of carotid artery stenosis by computed tomography angiography (CTA) based on cross-sectional area versus the smallest diameter measurement, and test the accuracy of both CTA measurements using color Doppler ultrasonography (CDUS) as a reference method.

Methods

For 113 carotid arteries with stenosis ≥50% we analysed the differences in the estimated stenosis level between both CTA methods and CDUS using the Bland-Altman approach. Further, we calculated sensitivity, specificity and plotted receiver operating characteristic (ROC) curves for both CTA methods.

Results

The mean difference between CDUS and CTA (area) measurements was −0.4% (p = 0.68); between CDUS and CTA (diameter), 20.7% (p < 0.001); and between CTA (area) and CTA (diameter), 21.2% (p < 0.001). Sensitivity and specificity for the CTA (area) method were 81% and 77%, and for CTA (diameter) were 23% and 100%. The area under the curve (AUC) for CTA (diameter) was 0.62 (0.57, 0.66), and for CTA (area) 0.79 (0.71–0.87). The equality test for the two AUCs was <0.0001.

Conclusions

CTA (diameter)-based measurements significantly underestimated the degree of carotid stenosis. We recommend the CTA (area) method because of its higher predictive power for a correct stenosis classification and a lack of significant difference in the estimated stenosis level, compared to CDUS.

Main messages

• Cross-sectional area measurement considers asymmetric shape of the residual vessel lumen.
• CTA (diameter) method on average significantly underestimates the true level of stenosis.
• CTA (area) method correctly classifies vessels needing surgical intervention.
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Metadata
Title
Grading of carotid artery stenosis with computed tomography angiography: whether to use the narrowest diameter or the cross-sectional area
Authors
Kristina Samarzija
Petar Milosevic
Zoran Jurjevic
Emilija Erdeljac
Publication date
01-08-2018
Publisher
Springer Berlin Heidelberg
Published in
Insights into Imaging / Issue 4/2018
Electronic ISSN: 1869-4101
DOI
https://doi.org/10.1007/s13244-018-0622-5

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