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Park, Choi, Shin, You, Park, Cho, Choi, Son, Choi, and Ryu: Bone Subtraction 3-Dimension CT Angiography Using 64-Slice Multidetector CT for the Evaluation of Steno-Occlusive Intra- and Extracranial Vascular Diseases: Comparison with Digital Subtraction Angiography
Neuroradiology
Journal of the Korean Society of Radiology

Journal of the Korean Society of Radiology 2012; 67(5): 309-317.

Published online: 21 November 2012

DOI: https://doi.org/10.0000/jksr.2012.67.5.309

Bone Subtraction 3-Dimension CT Angiography Using 64-Slice Multidetector CT for the Evaluation of Steno-Occlusive Intra- and Extracranial Vascular Diseases: Comparison with Digital Subtraction Angiography

Sung Eun Park, MD1, Dae Seob Choi, MD1, 2, Hwa Seon Shin, MD1, Jin Jong You, MD1, Mi Jung Park, MD1, Jae Min Cho, MD1, Ho Cheol Choi, MD1, Seungnam Son, MD3, Nack-Cheon Choi, MD2, 3, Jae Wook Ryu, MD4

1Department of Radiology, Gyeongsang National University School of Medicine, Jinju, Korea.

2Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea.

3Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea.

4Department of Radiology, Samsung Seoul Hospital, Seoul, Korea.

Corresponding author: Dae Seob Choi, MD. Department of Radiology, Gyeongsang National University School of Medicine, 79 Gangnam-ro, Jinju 660-702, Korea. Tel. 82-55-750-8211, Fax. 82-55-758-1568, choids@gnu.ac.kr

Received 16 June 2012       Accepted 9 August 2012

Copyright © 2012 The Korean Society of Radiology

Abstract

Purpose

To investigate the efficacy of bone subtraction CT angiography (BSCTA) for the evaluation of steno-occlusive intra- and extracranial vascular diseases.

Materials and Methods

Fifty-six patients were examined using 64-slice multidetector CT and digital subtraction angiography (DSA). For BSCTA, both nonenhanced CT and enhanced CT angiography (CTA) data sets were obtained. The stenotic degree of each vascular segment was assessed and classified into 5 grades. With DSA as the standard, CTA images were compared.

Results

For the evaluation of the extracranial vessels, 370 arterial segments were analyzed, and the stenotic degree revealed by CTA and DSA agreed in 359 (97.0%). There was a significant correlation between CTA and DSA (Rs = 0.974). For depiction of ≥ 50% stenosis, the sensitivity, specificity, and diagnostic accuracy of BSCTA were 100%, 98.2%, and 98.6%, respectively. For the intracranial arteries, 1029 segments were analyzed, and CTA agreed with DSA in 966 (93.9%). There was a significant correlation between CTA and DSA for stenotic degree (Rs = 0.880). For the depiction of ≥ 50% stenosis, the sensitivity, specificity, and diagnostic accuracy of CTA were 100%, 95.8%, and 96.0%, respectively. In all 74 segments of disagreement, the degree of stenosis was overestimated on CTA.

Conclusion

BSCTA is comparable to DSA for the evaluation of steno-occlusive intra- and extracranial vascular diseases. However, the stenotic degree tends to be overestimated on BSCTA, especially in cases of wall calcifications.

Keywords: CT Angiography, Bone Subtraction, Carotid Stenosis, Digital Subtraction Angiography

Figures and Tables

Fig. 1
A 75-year-old female patient with right MCA stenosis. Serial projection images of BSCTA show the entire neck and intracranial vessels with high quality. There is focal severe stenosis in M1 segment of the right MCA (arrow).
Note.-BSCTA = bone subtraction CT angiography, MCA = middle cerebral artery
jksr-67-309-g001
Fig. 2
A 65-year-old male patient with right ICA occlusion and left CCA and ICA stenosis.
A. Lateral view of the right CCA angiogram shows complete occlusion of the right proximal ICA.
B. Lateral view of the left CCA angiogram reveals mild segmental and severe focal narrowing in the left CCA (short arrow) and proximal ICA (long arrow).
C. BSCTA also shows the lesions as the same as on DSA (long and short arrows).
Note.-BSCTA = bone subtraction CT angiography, CCA = common carotid artery, DSA = digital subtraction angiography, ICA = internal carotid artery
jksr-67-309-g002
Fig. 3
A 67-year-old female patient with left proximal VA and subclavian artery stenosis.
A. DSA shows severe and moderate degree stenosis in the left proximal VA (arrow) and subclavian artery.
B. BSCTA reveals the stenotic lesions as the same degree as on DSA (arrow).
Note.-BSCTA = bone subtraction CT angiography, DSA = digital subtraction angiography, VA = vertebral artery
jksr-67-309-g003
Fig. 4
A 59-year-old male patient with left cavernous ICA stenosis.
A. DSA image shows focal luminal narrowing in the left cavernous ICA (arrow).
B. On BSCTA, the stenotic lesion (arrow) is overestimated compared to DSA.
Note.-BSCTA = bone subtraction CT angiography, DSA = digital subtraction angiography, ICA = internal carotid artery
jksr-67-309-g004
Fig. 5
A 65-year-old male patient with pseudostenosis.
A. DSA of the left VA injection shows no significant stenosis without mild luminal irregularity in the left distal VA (arrow).
B. On BSCTA, there is severe segmental narrowing in the left distal VA (arrow).
C. NECT reveals circumferential calcification in the left distal VA (arrow).
Note.-BSCTA = bone subtraction CT angiography, DSA = digital subtraction angiography, NECT = nonenhanced CT, VA = vertebral artery
jksr-67-309-g005
Table 1
Location of Lesions in the Extracranial Carotid and Vertebral Arteries
jksr-67-309-i001

Note.-CCA = common carotid artery, ICA = internal carotid artery, VA = vertebral artery

Table 2
Comparison of the Degree of Stenosis in the Extracranial Carotid and Vertebral Arteries with CTA and DSA
jksr-67-309-i002

Concordance rate = 359/370 = 97.0%.

Note.-CTA = CT angiography, DSA = digital subtraction angiography

Table 3
Location of Lesions in the Intracranial Arteries
jksr-67-309-i003

Note.-ACA = anterior cerebral artery, BA = basilar artery, ICA = internal carotid artery, MCA = middle cerebral artery, PCA = posterior cerebral artery, VA = vertebral artery

Table 4
Comparison of the Degree of Stenosis in the Intracranial Arteries with CTA and DSA
jksr-67-309-i004

Concordance rate = 966/1029 = 93.9%

Note.-CTA = CT angiography, DSA = digital subtraction angiography

Table 5
Concordance for the Stenotic Degree between CTA and DSA
jksr-67-309-i005

Note.-Rs = Spearman rank correlation coefficient (p < 0.001).

ACA = anterior cerebral artery, CCA = common carotid artery, CTA = CT angiography, DSA = digital subtraction angiography, ICA = internal carotid artery, MCA = middle cerebral artery, PCA = posterior cerebral artery, VA = vertebral artery

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