L'Angio-TC delle biforcazioni carotidee

Abstract

Computed Tomography (CT) now offers detailed information on the carotid bifurcation with short acquisition times and high spatial resolution. With new spiral acquisition devices it is possible to improve the quality of images and subsequent reconstruction with Multiplanar, Shaded Surface Display and Maximum Intensity Projection algorithms. In patients with atherosclerotic occlusive and stenotic disease CT clearly identifies the site and the type of plaque, distinguishing high density “hard” calcified plaque from soft fibrolipid build up which is hypodense with respect to the contrast enhanced lumen. In case of mixed plaque both components are well displayed as is their arrangement along the vessel wall. The endoluminal surface of the plaque is easily explored, sometimes disclosing small surface ulcerations resulting in emboli. CT is also able to measure the degree of lumen stenosis both applying the NASCET criteria and by calculating the ratio between total vessel area and residual lumen. Finally multiplanar and three-dimensional reconstructions offer a longitudinal view of the vessel and further information on the arrangement and size of the atheroma.