A correlative analysis on non-invasive medical imaging and endarterectomy in the diagnosis of carotid artery stenosis

Purpose To estimate the value of the non-invasive medical imaging in the evaluation of the extracranial carotid artery stenosis and provide some reference materials of the correlation between the medical imaging and the pathology in cases of the carotid artery stenosis. Methods 7 patients, 14 carotid arteries were studied with DUS, MRA, and CTA. CTMRI of the brain.The image findings in 3 patients were compared with DSA. 7 patients with severe stenosis received carotid endarterectomy. The comparison between the imaging findings and the pathology was made. Results In 7 patients with severe stenosis of carotid arteries, there were more infarction lesions revealed on the brain of the ipsilateral narrowing carotid artery distributions than those in the contrary side of the brain. Compared with the findings of operation, DUS diagnosed correctly 5 stenoses, MRA 6, and CTA 7 respectively. Agreement on location of stenosis between endarterectomy and findings showed by DUS, MRA and CTA was found in all cases. Histologically, areas of calcification and fibrosis were related to the high densities on CTA, strong echoes on DUS, and low signal intensities on MRA. While, lots of necrotic materials and foam cells accumulated with lipolytic materials on intimal surface of artery were seen in pathology, corresponding to the low, and iso-densities on CTA, low echoes on DUS, and inhomogeneous signal intensities on MRA. Conclusion The combined use of DUS, MRA, CTA improved the diagnostic accuracy for the assessment of carotid artery stenosis. CTA was more objective and accurate in the evaluation of the plaque.