Plaquemorphologie bei Karotisstenosen : Möglichkeiten der präoperativen Evaluation durch den 64-Zeiler-Dual-Source-Computertomographen im Vergleich mit den histopathologischen Ergebnissen

For the evaluation of the risk of stroke and the postoperativ outcome during a CEA the apprasial of the Plaquemorphology is amoung the graduation of the stenosis of the carotid artery the keyfaktor because the composition of the Plaque is an important determinate for the stability and the rate of embolisation. Therefore the intention our study is the preoperativ evaluation of the Plaque composition by using the Dual-Source CT and to compare the results with the histopathological findings. The uniqueness of our study is the scanner-technology, which uses the energy of two x-ray tubes to achive a faster image edition/processing and a higher spatial resolution. Addictionally the employing of two tubes with different energy allows faster and efficient postprocessing methods, specially for bone-subtration. We also compared the results of the CT-Angiography of the carotid artery with the findings of the MRA and the Colour-coded Ultrasound.PATIENTS AND METHODS: During the study 30 patients (meanage 70 years, min. 52, max. 85) underwent the DSCT und the degrees of the stenosis were appraised according the NASCET-criteria and the Plaquemorphology. Furthermore 15 symptomatic patients respectivly 30 carotid arteries were estimated by the Ultrasound and the MRA. During the operation specimens were extract from the Plaque and microscopic analysed. The findings were scaled along the AHA-Criteria und after that they were compared with the CT-Results and at last with the other imaging procedures.RESULTS AND CONCLUSION: Our results demonstrate a high correlation between the non-ivasive findings by the DSCT and the histopathology specimen. Although the DSCT-resolution is still below the histopathological examination it allows to show the main factors of vulnerable Plaques and a visiual and quantitative graduation of stenosis. As a result of the high correlation the DSCT-angiography was identified as a good non-invasive instrument for the preoperative evaluation and allows previously a good appraisal of the plaquemorphology and so of the stability of the plaque. The results are also comparable to the MR-Angiographie and the Ultrasound