Carotid artery plaque characteristics: current reporting practices on CT angiography
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DIAGNOSTIC NEURORADIOLOGY
Carotid artery plaque characteristics: current reporting practices on CT angiography Hediyeh Baradaran 1 & Tyrel Foster 1 & Paul Harrie 1 & J. Scott McNally 1 & Matthew Alexander 1 & Ankur Pandya 2 & Yoshimi Anzai 1 & Ajay Gupta 3,4 Received: 1 October 2020 / Accepted: 16 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Extracranial ICA imaging has largely focused on the degree of luminal stenosis, but recent advances suggest specific plaque features are crucial in stroke risk assessment. We evaluated the current state of reporting carotid plaque features on neck CTAs at an academic institution. Methods In this retrospective observational study, we included neck CTAs performed on patients over age 50 with any reported carotid plaque. We evaluated reports for mention of the following: degree of luminal stenosis, soft plaque, calcified plaque, plaque thickness, quantification of soft and calcified plaque, plaque ulceration, and increased risk associated with specific features. We used Fisher’s exact test to compare how often each feature was mentioned. Results We included a total of 651 reports from unique patients (mean age, 68.1 ± 13.3 years). A total of 639 reports (98.1%) explicitly mentioned degree of stenosis per NASCET criteria. Specific plaque features were less frequently characterized: soft plaque in 116 (17.8%); calcified plaque in 166 (25.5%); quantification of the amount of soft plaque and calcified plaque in 24 (3.7%) and 16 (2.5%) reports, respectively; plaque thickness in 12 (1.8%); plaque ulceration in 476 (73.1%); and increased risk associated with plaque in 2 (0.3%). Degree of stenosis was statistically more likely to be mentioned than any other plaque feature (p < 0.001). Conclusion Currently, nearly all reports mention the degree of luminal stenosis on neck CTAs while a significant minority mention specific plaque features. Despite mounting evidence of the importance of carotid plaque features in stroke risk assessment, radiology reports do not routinely report these findings. Keywords Carotid stenosis . Atherosclerosis . CT angiography
Introduction Computed tomography angiography (CTA) of the head and neck is commonly performed to evaluate the cervical carotid arteries, especially in the acute setting. One of the most
* Hediyeh Baradaran [email protected] 1
Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A141, Salt Lake City, UT 84135, USA
2
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
3
Department of Radiology, Weill Cornell Medicine, New York, NY, USA
4
Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
common indications for this examination is for the workup of stroke-like neurologic symptoms, specifically to evaluate the carotid artery. CTA is commonly used to evaluate carotid artery disease because it is the most accurate cross-sectional imaging technique compared to the
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