• Hiroki Kuroda, Yasunobu Nakai, Shigeta Miyake, Takahiro Mochizuki, Satoru Shimizu, Shunrou Fujiwara, Kuniaki Ogasawara, and Toshihiro Kumabe.
• Department of Neurosurgery, Yokohama Brain and Spine Center, Yokohama, Kanagawa, Japan; Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan; Department of Neurosurgery, Kuroda Neurosurgery Clinic, Sagamihara, Kanagawa, Japan. Electronic address: ktre29moon@hotmail.com.
• World Neurosurg. 2022 Nov 1; 167: e1219e1224e1219-e1224.

BackgroundPreoperative identification of the carotid bifurcation (CB) location and plaque and stenosis distal end of the cervical internal carotid artery in relation to bony structures is essential for carotid endarterectomy (CEA). However, for patients with contrast contraindications, cervical 3-dimensional computed tomography angiography (3D-CTA) is unavailable. In this study, we created fusion images of magnetic resonance angiography (MRA), black-blood (BB) magnetic resonance imaging (MRI), and CT to determine if these noncontrast agent images are superior to 3D-CTA for preoperative CEA planning.MethodsThe fusion images showed vascular structures obtained by MRA, plaque observed by BB-MRI, and bone structures shown by CT. Spatial localization accuracy was verified by directly overlaying contrast-enhanced 3D-CTA images on the fusion images. We validated this technique in 50 patients with unilateral ICA stenosis, 28 of whom underwent CEA. The 2D-distance CB MRA-CTA (the 2D distance difference between CB MRA and CB CTA perpendicular to the long axis of the carotid artery) was measured. We also compared the findings of the fusion image regarding the CB location and plaque distal end with the operative findings.ResultsThe median 2D distance CB MRA-CTA was 1 mm. CB MRA was located distal and proximal to CB CTA in 21and 29 patients, respectively. The CB location and fusion-image plaque were consistent with the intraoperative findings in all CEA patients.ConclusionsFusion images created from MRA, BB-MRI, and noncontrast CT were feasible as an alternative to 3D-CTA for patients with contrast contraindications.Copyright © 2022 Elsevier Inc. All rights reserved.

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