Comparison of multidetector-row computed tomography and duplex Doppler ultrasonography in detecting atherosclerotic carotid plaques complicated with intraplaque hemorrhage [Usporedba višeslojne kompjuterizirane tomografije i duplex Doppler ultrazvuka u otkrivanju aterosklerotskih karotidnih plakova kompliciranih krvarenjem u plak ]

This study compared sensitivity and specificity of multidetector-row computed tomography and duplex Doppler ultrasonography in detecting atherosclerotic carotid plaques complicated with intraplaque hemorrhage. Carotid plaques from 50 patients operated for carotid artery stenosis were analyzed. Carotid endarterectomy was performed within one week of diagnostic evaluation. Results of multidetector-row computed tomography and duplex Doppler ultrasonography diagnostic evaluation were compared with results of histological analysis of the same plaque areas. American Heart Association classification of atherosclerotic plaques was applied for histological classification. Median tissue density of carotid plaques complicated with intraplaque hemorrhage was 14.7 Hounsfield units. Median tissue density of noncalcified segments of uncomplicated plaques was 54.3 Hounsfield units (p = 0.00003). The highest tissue density observed for complicated plaques was 31.8 Hounsfield units. Multidetector-row computed tomography detected plaques complicated with hemorrhage with sensitivity of 100% and specificity of 70.4%, with tissue density of 33.8 Hounsfield units as a threshold value. Duplex Doppler ultrasonography plaque analysis based on visual in-line classification showed sensitivity of 21.7% and specificity of 89.6% in detecting plaques complicated with intraplaque hemorrhage. Multidetector-row computed tomography showed a very high level of sensitivity and a moderate level of specificity in detecting atherosclerotic carotid plaques complicated with hemorrhage. Duplex Doppler ultrasonography plaque analysis based on visual in-line classification showed a low level of sensitivity and a moderate-high level of specificity in detecting atherosclerotic carotid plaques complicated with hemorrhage

Retinal nerve fibre layer thickness in conditions of severe ischemia in patients without glaucoma

Introduction: Ischemia, most often caused by carotid disease, contributes to or causes a numerous ocular changes including optic nerve and ganglion cell damage, glaucoma, anterior and posterior segment changes. The perimetric changes in ischemia partially overlap with those caused by glaucoma. New diagnostic tools such as scanning laser polarimetry can detect retinal nerve fiber layer loss in glaucoma up to 6 years earlier than the first perimetric changes. Still, it is not yet clear if and up to what level laser polarimetry can show changes in RNFL caused by ischemia only, and whether these changes differ from the pure glaucomatous ones. In our pilot study we tried to investigate influence of significant carotid stenosis on retinal nerve fiber layer. Materials and Methods: Eight consecutive patients with carotid stenosis of more than 70% and no other eye disease influencing optic nerve. Results: RNFL loss can be found in the most of analyzed patients. The level of the RNFL impairment is not equal in the both eyes of patients having a different degree of stenosis on two sides probably due to the factors such as microvascular status. Conclusion: RNFL suffers changes in carotid stenosis. The results demand further investigation because the possibility of the precise estimation of ischemical damage to the RNFL can be of crucial importance in diagnosing and treatment of patients having glaucoma and ocular ischemia at the same time

Multidetector-row computed tomography in evaluation of atherosclerotic carotid plaques complicated with intraplaque hemorrhage

Objective: To determine sensitivity and specificity of multidetector-row computed tomography in detecting atherosclerotic carotid plaques complicated with intraplaque hemorrhage. ----- Material: Carotid plaques from 31 patients operated for carotid artery stenosis. ----- Methods: Results of preoperative multidetector-row computed tomography analysis of carotid plaques were compared with results of histological analysis of the same plaque areas. Carotid endarterectomy was performed within one week of multidetector-row computed tomography. American Heart Association classification of atherosclerotic plaques was applied for histological classification. ----- Results: Median tissue density of carotid plaques complicated with intraplaque hemorrhage was 22 Hounsfield units. Median tissue density of noncalcified segments of uncomplicated plaques was 59 Hounsfield units (p=0.0062). The highest tissue density observed for complicated plaques was 31 Hounsfield units. Multidetector-row computed tomography detected plaques complicated with hemorrhage with sensitivity of 100% and specificity of 64.7%, with tissue density of 31 Hounsfield units as a threshold value. ----- Conclusion: Multidetector-row computed tomography showed high level of sensitivity and moderate level of specificity in detecting atherosclerotic carotid plaques complicated with hemorrhage