Evaluation of image quality in carotid and cerebrovascular disease: a comparative study between subtraction and routine computed tomography angiography

Objective Few data exist comparing the image quality and diagnostic accuracy of subtraction computed tomography (CT) angiography (SCTA) in carotid and cerebrovascular arteries with routine CT angiography (RCTA). Patients and methods In this study, 56 patients underwent 128‐row CT angiography of these vessels with review by two radiologists using routine, nonsubtracted, and SCTA protocols. Comparisons were made using a 4‐point subjective rating scale in all patients. Eighteen patients were examined with both SCTA and invasive digital subtraction angiography (DSA). The accuracy of SCTA and routine CTA reformations was assessed and compared by both patient‐based and vessel‐based analyses of intracranial aneurysms and intracranial and extracranial arterial stenotic lesions using DSA results as the reference standard. Results Diagnostic accuracy in the adjacent skull base portion of the internal carotid artery (ICA) and reading time for cerebral aneurysms and vessel stenoses were obviously improved with SCTA protocol, but the accuracy in vertebro‐basilar arteries was no different. The diagnostic accuracy in general was slightly increased compared with routine CTA. Conclusion Review of SCTA images is an effective means to remove bone close to vessels as seen on routine CTA and has good image quality and diagnostic accuracy. SCTA is superior to routine CTA in the visualization and diagnostic accuracy of adjacent skull base part of the ICA and decreases reading time for carotid and cerebrovascular arterial imaging.