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Optimization of CT Angiography of the Carotid Artery with a 16-MDCT Scanner: Craniocaudal Scan Direction Reduces Contrast Material-Related Perivenous Artifacts

Cécile de Monyé1, Thomas T. de Weert1, William Zaalberg1, Filippo Cademartiri1, Dorine A. M. Siepman2, Diederik W. J. Dippel2 and Aad van der Lugt1

1 Department of Radiology, Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam, The Netherlands, 3015 GD.
2 Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands.


Figure 1
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  		Fig. 1A —CT angiograms of supraaortic arteries in 74-year-old woman scanned in caudocranial direction with left-sided injection of contrast material. Coronal maximum intensity projection (15 mm). High-density contrast material in left subclavian vein and reflux of contrast material in neck veins give rise to artifacts over origin of supraaortic vessels.

 

Figure 2
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  		Fig. 1B —CT angiograms of supraaortic arteries in 74-year-old woman scanned in caudocranial direction with left-sided injection of contrast material. Axial image at level of origin of left vertebral artery (arrow).

 

Figure 3
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  		Fig. 1C —CT angiograms of supraaortic arteries in 74-year-old woman scanned in caudocranial direction with left-sided injection of contrast material. Axial image at level of proximal part of left common carotid artery (arrow) and left subclavian artery (arrowhead).

 

Figure 4
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  		Fig. 1D —CT angiograms of supraaortic arteries in 74-year-old woman scanned in caudocranial direction with left-sided injection of contrast material. Axial image at level of first 1 cm of brachiocephalic trunk (long arrow) and left common carotid artery (short arrow). Evaluation of atherosclerotic disease is hampered by streak artifacts.

 

Figure 5
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  		Fig. 2A —CT angiograms of supraaortic arteries. Four maximum intensity projections (30 mm) in coronal plane in four patients. CT angiographic scans in caudocranial direction with right-sided (72-year-old man, A) and left-sided (74-year-old woman, B) injection of contrast material. Very high density of contrast material in subclavian vein and superior vena cava hides origin of supraaortic arteries.

 

Figure 6
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  		Fig. 2B —CT angiograms of supraaortic arteries. Four maximum intensity projections (30 mm) in coronal plane in four patients. CT angiographic scans in caudocranial direction with right-sided (72-year-old man, A) and left-sided (74-year-old woman, B) injection of contrast material. Very high density of contrast material in subclavian vein and superior vena cava hides origin of supraaortic arteries.

 

Figure 7
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  		Fig. 2C —CT angiograms of supraaortic arteries. Four maximum intensity projections (30 mm) in coronal plane in four patients. CT angiographic scans in craniocaudal direction with right-sided (48-year-old man, C) and left-sided (54-year-old man, D) injection of contrast material. High density of contrast material is not left in veins, and all arteries are clearly depicted.

 

Figure 8
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  		Fig. 2D —CT angiograms of supraaortic arteries. Four maximum intensity projections (30 mm) in coronal plane in four patients. CT angiographic scans in craniocaudal direction with right-sided (48-year-old man, C) and left-sided (54-year-old man, D) injection of contrast material. High density of contrast material is not left in veins, and all arteries are clearly depicted.

 

Figure 9
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  		Fig. 3A —Contrast material-related perivenous artifacts graded on four-point scale in four different patients. Score of 0 indicates no streak artifacts and clear anatomic detail in 39-year-old man.

 

Figure 10
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  		Fig. 3B —Contrast material-related perivenous artifacts graded on four-point scale in four different patients. Score of 1 indicates minimal streak artifacts without notable obscuration of adjacent arteries in 40-year-old woman.

 

Figure 11
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  		Fig. 3C —Contrast material-related perivenous artifacts graded on four-point scale in four different patients. Score of 2 indicates moderate streak artifacts partially obscuring adjacent arteries in 59-year-old man.

 

Figure 12
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  		Fig. 3D —Contrast material-related perivenous artifacts graded on four-point scale in four different patients. Score of 3 indicates extensive streak artifacts completely obscuring adjacent arteries in 63-year-old man.

 

Figure 13
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  		Fig. 4 —Time-attenuation curves show intraluminal attenuation at slice number from caudal to cranial. Slightly lower attenuation is evident for craniocaudal scan direction in comparison with caudocranial scan direction.

 

Figure 14
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  		Fig. 5 —Intraluminal attenuation of group 1 (caudocranial scan direction) and group 2 (craniocaudal scan direction) at different locations from ascending aorta (asc ao) to circle of Willis. Maximum attenuation was reached in proximal internal carotid artery (ICA) in both groups. Prox = proximal, CCA = common carotid artery, Dist = distal, Intracran = intracranial arteries.

 

Figure 15
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  		Fig. 6A —Box -and-whisker plots of attenuation in superior vena cava (SVC) and of reflux of contrast material in neck veins according to artifact score. Plot shows clear cutoff point at ± 200 H attenuation of SVC. Above this level artifacts interfered with evaluation of arteries. Circle indicates outlier.

 

Figure 16
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  		Fig. 6B —Box -and-whisker plots of attenuation in superior vena cava (SVC) and of reflux of contrast material in neck veins according to artifact score. Plot shows greater amount of reflux is associated with higher artifact score. Stars indicate extremes.

 

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