Computed Tomography

Diagnosing Bilateral Subclavian Artery Disease usi

Diagnosing Bilateral Subclavian Artery Disease using VesselIQ Xpress


CT Clinical Case Study CT Angiography


Jean Marc Treutenaere, M.D.
Caroline Jardin, M.D.
Jean Louis Sablayrolles, M.D.
Jacques Feignoux, M.D.
Centre Cardiologique du Nord
Saint-Denis, France

Patient history

A 46-year-old female patient presented with right upper extremity pain and slight discomfort of the left arm. Endovascular treatment of posterior communicating artery aneurysm. She had a history of hyper arterial pressure from the age of 18 years old (HTA).


Acquisition protocol

  • Scanner: GE Healthcare LightSpeed® VCT
  • Scan type: CT Angiography carotid study – Helical
  • kVp: 120
  • AutomA: 250-660
  • Rotation speed: 0.4 second
  • mAs: 100-264
  • Noise index: 12
  • Slice thickness: 0.625 mm
  • Collimation: 40 mm (64 x 0.625 mm)
  • Pitch: 0.984:1
  • SFOV: 50 cm


Advanced application

VesselIQ™ Xpress – Neck protocol


Contrast injection parameters

  • Total contrast volume: 100 ml iodine + 40 ml saline flush
  • Contrast injection rate: 4 ml/second for iodine + 2 ml/second for saline


Figure 1: 3D volume-rendered model demonstrating right subclavian thrombosis

Figure 1: 3D volume-rendered model demonstrating right subclavian thrombosis


Figure 2: Curved MPR demonstrating right subclavian thrombosis

Figure 2: Curved MPR demonstrating right subclavian thrombosis


Figure 3: Lumen view demonstrating right subclavian thrombosis

Figure 3: Lumen view demonstrating right subclavian thrombosis


Diagnosis

Clinical findings
Thrombosis of the right subclavian artery. Severe stenosis of the left subclavian artery (84% in area, 64% in diameter) was detected and measured with stenosis tool with VesselIQ Xpress. Tiny atheromateous calcified plaque at the left carotid bifurcation was also identified.

Interventions
Bypass between the right carotid and right axillary arteries, with angioplasty planned for the left side.


Discussion

The CTA exam images helped the radiologist determine the following:

  • Long anatomical coverage from the aortic arch to the Circle of Willis in high resolution is achieved within the arterial phase with just a 3-second acquisition time.
  • AutoBone extraction easily shows the left subclavian stenosis and the right subclavian thrombosis. Quick AVA can be applied to quantify the severity of the stenosis.
  • The left carotid and right carotid are analyzed with dedicated, efficient carotid tracking.
  • AutoBone removal for the head drastically improves workflow.


Figure 4: 3D volume-rendered model demonstrating left subclavian stenosis

Figure 4: 3D volume-rendered model demonstrating left subclavian stenosis


Figure 5: Lumen view demonstrating left subclavian artery stenosis

Figure 5: Lumen view demonstrating left subclavian artery stenosis


Figure 6: Transparent bone with vascular imaging

Figure 6: Transparent bone with vascular imaging


Figure 7: Curved MPR demonstrating left subclavian stenosis

Figure 7: Curved MPR demonstrating left subclavian stenosis


Figure 8: Transparent bone with vascular imaging

Figure 8: Transparent bone with vascular imaging