NASCET percent stenosis semi-automated versus manual measurement on CTA.

PURPOSE: To compare North American Symptomatic Carotid Endarterectomy Trial (NASCET) stenosis values and NASCET grade categorization (mild, moderate, severe) of semi-automated vessel analysis software versus manual measurements on computed tomography angiography (CTA). METHODS: There were four observers. Two independently analyzed 81 carotid artery CTAs using semi-automated vessel analysis software according to a blinded protocol. The software measured the narrowest stenosis in millimeters (mm), distal internal carotid artery (ICA) in mm, and calculated percent stenosis based on NASCET criteria. One of these two observers performed this task twice on each carotid, the second analysis was delayed two months in order to mitigate recall bias. Two other observers manually measured the narrowest stenosis in mm, distal ICA in mm, and calculated NASCET percent stenosis in a blinded fashion. The calculated NASCET stenoses were categorized into mild, moderate, or severe. Chi square and analysis of variance (ANOVA) were used to test for statistical differences. RESULTS: ANOVA did not find a statistically significant difference in the mean percent stenosis when comparing the two manual measurements, the two semi-automated measurements, and the repeat semi-automated. Chi square demonstrated that the distribution of grades of stenosis were statistically different (p<0.05) between the manual and semiautomated grades. Semi-automated vessel analysis tended to underestimate the degree of stenosis compared to manual measurement. CONCLUSION: The mean percentage stenosis determined by semi-automated vessel analysis is not significantly different from manual measurement. However, when the data is categorized into mild, moderate and severe stenosis, there is a significant difference between semi-automated and manual measurements. The semi-automated software tends to underestimate the stenosis grade compared to manual measurement.

Reproducibility of semi-automated measurement of carotid stenosis on CTA.

PURPOSE: To compare the reproducibility of semi-automated vessel analysis software to manual measurement of carotid artery stenosis on computed tomography angiography (CTA). METHODS: Two observers separately analyzed 81 carotid artery CTAs using semi-automated vessel analysis software according to a blinded protocol. The software measured the narrowest stenosis in millimeters (mm), distal internal carotid artery (ICA) in mm, and calculated percent stenosis based on NASCET criteria. One observer performed this task twice on each carotid, the second analysis delayed two months in order to mitigate recall bias. Two other observers manually measured the narrowest stenosis in mm, distal ICA in mm, and calculated NASCET percent stenosis in a blinded fashion. Correlation coefficients were calculated for each group comparing the narrowest stenosis in mm, distal ICA in mm, and NASCET percent stenosis. RESULTS: The semi-automated vessel analysis software provided excellent intraobserver correlation for narrowest stenosis in mm, distal ICA in mm, and NACSET percent stenosis (Pearson correlation coefficients of 0.985, 0.954, and 0.977 respectively). The semi-automated vessel analysis software provided excellent interobserver correlation (0.925, 0.881, and 0.892 respectively). The interobserver correlation for manual measurement was good (0.595, 0.625, and 0.555 respectively). There was a statistically significant difference in the interobserver correlation between the semi-automated vessel analysis software observers and the manual measurement observers (P < 0.001). CONCLUSION: Semi-automated vessel analysis software is a highly reproducible method of quantifying carotid artery stenosis on CTA. In this study, semi-automated vessel analysis software determination of carotid stenosis was shown to be more reproducible than manual measurement.

Rotator cuff troublemakers: pitfalls of MRI and ultrasound.

Rotator cuff pathology is routinely evaluated in many imaging centers with both magnetic resonance imaging (MRI) and ultrasound. Despite good diagnostic accuracy using each of these modalities, certain limitations persist. In this pictorial essay, we describe five potential "troublemakers" of rotator cuff pathology which are recurrent themes in our busy shoulder referral center. The comparison of imaging findings on MRI and ultrasound are discussed. An awareness of these potential pitfalls will help improve radiologists' diagnostic accuracy of rotator cuff pathology, and allow the clinician to optimize imaging referral and better interpret the subsequent report.

Diagnosis and anatomic mapping of an orbital varix by computed tomographic angiography.

PURPOSE: To report the use of computed tomographic angiography (CTA) to diagnose an orbital varix. DESIGN: Observational case report. METHODS: A 73-year-old female was investigated by CTA for carotid artery stenosis. An incidental orbital lesion was discovered. Reformations were obtained. RESULTS: CTA demonstrated a homogeneously enhancing orbital apex lesion. It provided exceptional anatomic detail of inflow and outflow veins, confirming the diagnosis of an orbital varix. CONCLUSIONS: CTA is cost effective, fast, non-invasive, and readily available. These aspects combined with the exceptional vascular detail obtained may make CTA the primary test for orbital varix diagnosis.