Atherosclerotic carotid plaque assessment with multidetector computed tomography angiography

This thesis evaluates the role of MDCT angiography in 1) the depiction of atherosclerotic disease and subsequent luminal stenosis in the arteries that supplies the brain with blood, and 2) the assessment of atherosclerotic plaque features that have been related to plaque vulnerability. The studies can be subdivided in three main categories: 1) optimization of data acquisition protocol, 2) validation studies, including assessment of the accuracy of MDCTA in comparison to histology and interobserver studies, and 3) clinical cross-sectional studies. From the first part of this thesis we can conclude that an optimal protocol for MDCT angiography of the supra-aortic arteries incorporates the use of 80 ml contrast material and a 40 ml saline bolus chaser, a craniocaudal scan direction, and in respect to atherosclerotic carotid plaque imaging a tube current of 120 kVp and an intermediate reconstruction algorithm. The second part of this thesis allows to conclude that MDCTA is capable of characterizing and quantifying plaque and plaque component areas in good correlation with histology. However, lipid core can only be adequately quantified in mildly calcified plaques, and in vivo assessment of atherosclerotic plaque and plaque component volumes is feasible with a moderate reproducibility. In addition we can conclude that, with MDCT angiography, intracranial carotid artery calcifications can reproducibly be quantified and that carotid plaque surface morphology can be assessed with a high reproducibility. In the third part of this thesis we evaluated the characteristics of possible MDCTA-assessed plaque parameters (the volume of intracranial calcifications, carotid plaque morphology, and carotid plaque volume and plaque component volumes). Associations were found with several cardiovascular risk factors. Some plaque parameters were related to the presence and type of cerebrovascular symptomatology. We conclude that atherosclerotic plaque parameters can be imaged adequately with MDCTA. These parameters seem to have a possible additional value, besides the degree of stenosis, as a marker of atherosclerotic disease and as predictor of (recurrent) ischemic cerebrovascular events.

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