Assessments of arterial and venous phase radiodensity does not improve carotid near-occlusion diagnostics

TL;DR

This study found that measuring radiodensity beyond carotid stenosis in CT scans does not reliably distinguish near-occlusions from regular stenoses.

Contribution

The study evaluates whether arterial and venous phase radiodensity assessments can improve carotid near-occlusion diagnostics.

Findings

Near-occlusions showed lower arterial phase radiodensity and higher venous phase radiodensity compared to conventional stenoses.

Diagnostic performance of radiodensity metrics was poor with area under the curve ≤ 0.82.

Radiodensity differences were most noticeable in near-occlusions with large side-to-side diameter differences.

Abstract

The hypothesis of this study was that evaluation of radiodensity assessment beyond a carotid stenosis in arterial and/or venous phase can be used to separate near-occlusion and conventional ≥ 50% stenosis. We prospectively included participants with ≥ 50% carotid stenosis with inclusion preference for cases with extracranial internal carotid artery (ICA) asymmetry. All participants were examined with a research biphasic computed tomography angiography (CTA) protocol (arterial and venous phase). Reference diagnosis was set by interpretation on CTA and radiodensity difference between ipsilateral and contralateral ICA (c-corrected) or vertebral (v-corrected) was compared. We included 93 participants, 62 with near-occlusion and 31 with conventional ≥ 50% stenosis. Just beyond the stenosis, median c-corrected radiodensity was − 20 Hounsfield units (HU) among near-occlusions and − 1 HU among conventional ≥ 50% stenoses (p < 0.001) in the arterial phase. For the venous phase, these findings were + 17 HU and + 3 HU (p = 0.007). Similar group differences were seen for v-correction. No parameter had good diagnostic performance, area under the curve ≤ 0.82. With specificity set at ≥ 95%, detected near-occlusions were foremost those with large side-to-side differences in distal ICA-diameter. Carotid near-occlusions can have reduced radiodensity beyond the stenosis in arterial phases and increased radiodensity in venous phases compared to a reference artery—which was not clearly seen for conventional stenoses. However, these radiodensity findings are best seen in near-occlusion cases that are not diagnostically challenging, while they work poorly as additional diagnostic aids.

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