The application of 64 multidetector CT angiography in the evaluation of proximal vertebral artery stenosis

Objective:To evaluate the diagnostic value of 64 multidetector CT angiography (CTA) for proximal vertebral artery stenosis compared with digital subtraction angiography (DSA). Methods: All patients with interpretable CTA and DSA of the proximal vertebral arteries from Dec. 2005 to Apr. 2008 were included in this study. This yieled a total of 796 vessels. Two senior neuroradiologists graded the CTA and DSA images referring to the distal vertebral artery, according to the North American Symptomatic Carotid Endarterectomy Trial guidelines. Comparison of CTA with DSA in detecting the soft plaque of vertebral artery. Statistical significance was determined using χ2 test. Results: Referring to the DSA, the overall sensitivity, specificity, positive predictive value and negative predictive value to diagnose proximal vertebral artery stenosis by 64 MSCT were 100%, 97.6%, 93.9% and 100% respectively, and were 100%, 97.3%, 82.1%, 100% respectively when proximal vertebral artery with stenosis≥50%, and were 92.0%, 100%, 100%, 99.5% respectively when proximal vertebral artery had central stenosis50%, and were 92.0%, 100%, 100%, 99.5% respectively when proximal vertebral artery had eccentric stenosis50%. There was statistically significant difference in detecting soft plaque between CTA and DSA (P0.05). Conclusions: CTA has a high sensitivity, high specificity, high negative predictive value for proximal vertebral artery stenosis, and has a higher accura- cy in evaluating soft plaque and proximal vertebral artery eccentric stenosis than DSA. CTA appears to be an excellent evalu- ating test for proximal vertebral artery stenosis.