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From the Division of Cardiology and Vascular Medicine (R.C., C.F., M.R.,
A.G.), Radiology (M.A.), and Neurology (P.L.P.), Ospedale San Giovanni,
(E.O.C.) Bellinzona, Switzerland.
Correspondence to Prof Dr Med Gallino Augusto, Chief of the Division of Cardiology and Vascular Medicine, Ospedale San Giovanni, (E.O.C.) 6500 Bellinzona, Switzerland. E-mail osgin3{at}tinet.ch
Background—For the detection of
atherosclerotic lesions of the extracranial cerebral arteries, duplex
ultrasonography (US) is an established operator-dependent method,
whereas arteriography is associated with the not-insignificant risk of
embolic complications. Spiral CT is a promising novel
diagnostic tool that allows noninvasive,
operator-independent diagnosis of obstruction of extracranial cerebral
arteries. The aim of our prospective study was to evaluate in a
clinical setting the complementary role of duplex US and spiral
CT.
Methods and Results—We compared the results obtained
independently by spiral CT and duplex US in 59 consecutive patients
with clinical suspicion of an obstructive lesion affecting the carotid
arteries. We analyzed a total of 354 segments from the
extracranial carotid arteries, including the common, internal, and
external carotid arteries. A total of 4 complete occlusions, 38 severe
stenoses (70% to 99%), and 32 moderate stenoses (30%
to 69%) were concordantly identified by means of duplex US and spiral
CT. In 5 cases in which duplex US did not allow sufficient evaluation
of the carotid artery because of a poor US window or severe
calcification, spiral CT allowed identification and correct measurement
of the stenotic lesion. The comparison of the percentage of
stenosis with both methods was good (r=0.91,
P=0.024).
Conclusions—Our results indicate that spiral CT of the
extracranial cerebral arteries is a promising noninvasive complementary
and non–operator-dependent examination. Its application is
particularly attractive in cases in which duplex US is not reliable
(ie, severe kinking, severe calcification, short neck, and high
bifurcation) and particularly when an overall view of the vascular
field is required.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Spiral Computed Tomography
A Novel Diagnostic Approach for Investigation of the Extracranial Cerebral Arteries and Its Complementary Role in Duplex Ultrasonography
Key Words: angiography • arteries • imaging • stenosis • tomography
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