Examination of the extracranial carotid bifurcation by thin-section dynamic CT: direct visualization of intimal atheroma in man (Part 2).

Examination of the extracranial carotid bifurcation by thin-section computed tomographic (CT) scans after bolus, high-volume contrast enhancement allowed detection of more disease than did arteriograms in six of eight consecutive patients with transient ischemic attacks. In four patients this was on the clinical side of the lesion; in two the disease was in the asymptomatic carotid artery. One patient appeared to show a carotid ulcer; the ulcer was detected on CT. However, at surgery and subsequent histology, the surface of the lesion was endothelialized. The carotid CT examination is performed in the scanner "dead time" between unenhanced and enhanced head CT scans using the same contrast material for both studies. The examinations covers 3-3.6 cm of the carotid bifurcation region. Thin-section CT of the extracranial carotid arteries is a noninvasive examination that on preliminary evaluations appears to have sensitivity at least equal to that of carotid angiography in the detection of intimal disease.