Computed tomography angiography vs 3 T black-blood cardiovascular magnetic resonance for identification of symptomatic carotid plaques

Background: the purpose of this prospective study was to perform a head-to-head comparison of the two methods most frequently used for evaluation of carotid plaque characteristics: multi-detector computed tomography angiography (mdcta) and black-blood 3 t-cardiovascular magnetic resonance (bb-cmr) with respect to their ability to identify symptomatic carotid plaques.methods. 22 stroke unit patients with unilateral symptomatic carotid disease and >50% stenosis by duplex ultrasound underwent mdcta and bb-cmr (tof,pre- and post-contrast fst1w-,and fst2w- sequences) within 15 days of symptom onset. both symptomatic and contralateral asymptomatic sides were evaluated. by bb-cmr,plaque morphology,composition and prevalence of complicated aha type vi lesions (aha-lt6) were evaluated. by mdcta,plaque type (non-calcified,mixed,calcified),plaque density in hu and presence of ulceration and/or thrombus were evaluated. sensitivity (se),specificity (sp),positive and negative predictive value (ppv,npv) were calculated using a 2-by-2-table.results: to distinguish between symptomatic and asymptomatic plaques aha-lt6 was the best cmr variable and presence / absence of plaque ulceration was the best ct variable,resulting in a se,sp,ppv and npv of 80%,80%,80% and 80% for aha-lt6 as assessed by bb-cmr and 40%,95%,89% and 61% for plaque ulceration as assessed by mdcta. the combined se,sp,ppv and npv of bb-cmr and mdcta was 85%,75%,77% and 83%,respectively.conclusions: bb-cmr is superior to mdcta at identifying symptomatic carotid plaques,while mdcta offers high specificity at the cost of low sensitivity. results were only slightly improved over bb-cmr alone when combining both techniques. © 2014 grimm et al.; licensee biomed central.