Affiliation:
1. Department of Neurology Beijing Tiantan Hospital, Capital Medical University Beijing China
2. China National Clinical Research Center for Neurological Diseases Beijing Tiantan Hospital, Capital Medical University Beijing China
3. CT Clinical Specialist Philips Healthcare Beijing China
4. Tiantan Neuroimaging Center of Excellence China National Clinical Research Center for Neurological Diseases Beijing China
5. Research Unit of Artificial Intelligence in Cerebrovascular Disease Chinese Academy of Medical Sciences Beijing China
Abstract
Background
Dual‐layer spectral‐detector dual‐energy computed tomography angiography (DLCTA) can distinguish components of carotid plaques. Data on identifying symptomatic carotid plaques in patients using DLCTA are not available.
Methods and Results
In this prospective observational study, patients with carotid plaques were enrolled and received DLCTA. The attenuation for both polyenergetic image and virtual monoenergetic images (40, 70, 100, and 140 keV), as well as
Z
‐effective value, were recorded in the noncalcified regions of plaques. Logistic regression models were used to assess the association between attenuations of DLCTA and the presence of symptomatic carotid plaques. In total, 100 participants (mean±SD age, 64.37±8.31 years; 82.0% were men) were included, and 36% of the cases were identified with the symptomatic group. DLCTA parameters were different between 2 groups (symptomatic versus asymptomatic: computed tomography [CT] 40 keV, 152.63 [interquartile range (IQR), 70.22–259.78] versus 256.78 [IQR, 150.34–408.13]; CT 70 keV, 81.28 [IQR, 50.13–119.33] versus 108.87 [IQR, 77.01–165.88]; slope
40–140 keV
, 0.91 [IQR, 0.35–1.87] versus 1.92 [IQR, 0.96–3.00];
Z
‐effective value, 7.92 [IQR, 7.53–8.46] versus 8.41 [IQR, 7.94–8.92]), whereas no difference was found in conventional polyenergetic images. The risk of symptomatic plaque was lower in the highest tertiles of attenuations in CT 40 keV (adjusted odds ratio [OR], 0.243 [95% CI, 0.078–0.754]), CT 70 keV (adjusted OR, 0.313 [95% CI, 0.104–0.940]),
Z‐
effective values (adjusted OR, 0.138 [95% CI, 0.039–0.490]), and slope
40–140 keV
(adjusted OR, 0.157 [95% CI, 0.046–0.539]), with all
P
values and
P
trends <0.05. The areas under the curve for CT 40 keV, CT 70 keV, slope 40 to 140 keV, and
Z
‐effective values were 0.64, 0.61, 0.64, and 0.63, respectively.
Conclusions
Parameters of DLCTA might help assist in distinguishing symptomatic carotid plaques. Further studies with a larger sample size may address the overlap and improve the diagnostic accuracy.
Publisher
Ovid Technologies (Wolters Kluwer Health)