J Korean Soc Radiol.  2012 Nov;67(5):309-317. 10.3348/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

• Park SE
• Choi DS
• Shin HS
• You JJ
• Park MJ
• Cho JM
• Choi HC
• Son S
• Choi NC
• Ryu JW

• KMID: 1819745
• DOI: http://doi.org/10.3348/jksr.2012.67.5.309

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 > or = 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 > or = 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.

MeSH Terms

Angiography
Angiography, Digital Subtraction
Arteries
Carotid Stenosis
Constriction, Pathologic
Humans
Sensitivity and Specificity
Vascular Diseases

Figure

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  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

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  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

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  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

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  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

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  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

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