The gold standard for NASCET-type stenosis measurements is currently 2D digital subtraction angiography (DSA). In this paper, we evaluate the efficacy of 3D cone-beam, Volumetric Subtraction Angiography (VSA) for assessing internal carotid artery stenosis, by comparison with conventional DSA. VSA perspective maximum intensity projections (MIPs) and DSAs were assessed separately for NASCET-type, minimum stenosis measurements. Although virtually any viewing angle of the VSA was possible, the minimum stenosis grades were not significantly higher than that of the DSAs. Our study of 38 arteries yielded a sensitivity and specificity of 100% (using a clinically relevant 60% stenosis threshold). Measurements from three neuroradiologists provided an average stenosis grade of 75 +/- 6% and 76 +/- 7% for the DSA and VSA respectively. A paired student t-test indicated a 98% confidence of no statistical difference in the means. Thus, VSA provides gold standard 3D information about carotid lumen geometry. While not intended to supplant noninvasive techniques during routine clinical diagnosis, it does provide a 3D reference standard for research investigations. Additionally, cone-beam CT can provide quantification of calcification around the carotid bifurcation.

Date Published: 17 May 2002
PDF: 8 pages
Proc. SPIE 4681, Medical Imaging 2002: Visualization, Image-Guided Procedures, and Display, (17 May 2002); doi: 10.1117/12.466944

Published in SPIE Proceedings Vol. 4681:
Medical Imaging 2002: Visualization, Image-Guided Procedures, and Display
Seong Ki Mun, Editor(s)