Blinded-reader comparison of magnetic resonance angiography and duplex ultrasonography for carotid artery bifurcation stenosis.

Mittl, R L; Broderick, Magie; Carpenter, Jeffrey P.; Goldberg, Herbert I.; Listerud, John; Mishkin, Mark M.; Berkowitz, Henry D.; Atlas, Scott W.

doi:10.1161/01.str.25.1.4

Cited by 111 publications

(53 citation statements)

References 31 publications

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“…Of the resulting sample of 162 studies, 93 were published before 1991 and 69 were published between 1993 and 1997. Twenty studies from each period were randomly selected for detailed review (1970 -1991 [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] and 1993-1997 [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64]. No studies by any of the authors were selected, and thus there was no conflict of interest.…”

Section: Resultsmentioning

confidence: 99%

Critical Appraisal of the Design and Reporting of Studies of Imaging and Measurement of Carotid Stenosis

Rothwell

Pendlebury

Wardlaw

et al. 2000

Stroke

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Background and Purpose-Several hundred studies have been published over the last few years on imaging and measurement of carotid stenosis. Despite all this research, there is still no consensus about how best to image and measure stenosis. One possible explanation for this is that many of the studies have not been large enough or methodologically sound enough to allow useful conclusions to be drawn. We aimed to assess the design and methods of a random sample of published studies of imaging and measurement of carotid stenosis using 9 simple criteria. Methods-A formal literature search was performed for studies of imaging and measurement of carotid stenosis. Two subsets were randomly selected for detailed assessment: 20 studies published before 1991 and 20 published between 1993 and 1997 (some years after the initial publication of the ECST and NASCET trials). The criteria used to assess the selected studies were as follows: prospective rather than retrospective study design; patient selection based on a consecutive series or a random sample; adequate detail of study population; adequate detail of imaging techniques; inclusion of all investigations, ie, patients with poor-quality imaging were not excluded; blinded assessment of images; adequate detail of derivation of measurement of stenosis from images or data; adequate data on the reproducibility of measurements of stenosis; and study powered according to a sample-size calculation. Results-There were many basic methodological deficiencies in both subsets of studies, with relatively little evidence of improvement with time. For example, only 33% of studies were prospective, only 45% studied a consecutive or random selection of patients, and only 38% reported any data on the reproducibility of measurements. More than half of the studies satisfied Յ4 of the 9 quality criteria. However, there was considerable variation between studies, with 7 studies satisfying Ն7 criteria and 10 studies satisfying Յ2. No study was based on a sample-size calculation. The number of patients studied was often small, particularly in the more recent studies: median sample size was 100 in the 1970 -1990 studies and 58 in the 1993-1997 studies (PϽ0.0001). Conclusions-The design and reporting of published studies of imaging and measurement of carotid stenosis are poor and have not improved much in recent years. The majority of published studies are not of a sufficient standard to enable the results to be used to inform clinical practice. The utility of future studies could be improved considerably by better adherence to 9 simple methodological guidelines.

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Section: Resultsmentioning

confidence: 99%

Critical Appraisal of the Design and Reporting of Studies of Imaging and Measurement of Carotid Stenosis

Rothwell

Pendlebury

Wardlaw

et al. 2000

Stroke

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show abstract

“…[7][8][9] This argument is based on the relative accuracy of Doppler ultrasound in previous studies. 5,6,[12][13][14][15] Dawson et al 5 prospectively studied 103 patients with 111 carotid stenoses with duplex scanning and conventional angiography. Carotid duplex studies were performed at vascular laboratories at 2 institutions.…”

Section: Discussionmentioning

confidence: 99%

Role of Conventional Angiography in Evaluation of Patients With Carotid Artery Stenosis Demonstrated by Doppler Ultrasound in General Practice

Qureshi

Suri

Ali

et al. 2001

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Background and Purpose-Previous studies have suggested that patients with carotid stenosis who are candidates for endarterectomy can be effectively identified on the basis of carotid Doppler ultrasound alone. Before widespread acceptance of this policy, the accuracy of carotid Doppler ultrasound outside selected centers and clinical trials needs to be evaluated. We performed a 12-month prospective study to evaluate the accuracy of Doppler ultrasound in identifying patients for carotid intervention in general practice settings. Methods-Each patient referred to our endovascular service for diagnostic angiography to evaluate for carotid stenosis was interviewed and examined by a neurologist. Subjects consisted of symptomatic patients with Ն50% stenosis and asymptomatic patients with Ն60% stenosis by Doppler ultrasound. Information pertaining to demographic and cerebrovascular risk factors and the results of the carotid Doppler ultrasound were recorded. The severity of stenosis on angiograms was measured with North American Symptomatic Carotid Endarterectomy Trial criteria by a blinded observer. The results of both studies were compared to determine the relative accuracy of ultrasound results. Results-Of 130 patients (mean age, 69Ϯ8.8 years) who met Doppler ultrasound criteria, 22 (17%) and 8 patients (6%)were found to have 30% to 49% or Ͻ30% stenosis by angiography, respectively. The positive predictive value of carotid Doppler ultrasound for identifying appropriate symptomatic candidates for carotid intervention (angiographic stenosis Ն50%) was 80%, with a false-positive value of 20%. The positive predictive value of carotid Doppler ultrasound for identifying appropriate asymptomatic candidates for carotid intervention (angiographic stenosis Ն60%) was 59%, with a false-positive value of 41%. Carotid endarterectomy or angioplasty and stent placement were undertaken subsequently in 60 (46%) of the patients. In 94 patients who underwent cerebral angiography alone, no complications were observed. Conclusions-The present accuracy of carotid Doppler ultrasound in general practice does not justify its use as the sole basis of selecting appropriate patients for carotid intervention. Given the relatively low rate of associated morbidity with present day techniques, additional confirmatory studies such as angiography should be performed in every patient before a decision regarding intervention is made.

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“…Table 1 summarizes many of the recent prospective comparisons of MRA and CA for the evaluation of the carotid bifurcation. [37][38][39][40][41][42][43][44][45][46][47][48][49] The median sensitivity for a high-grade lesion was 93%, whereas the median specificity was 88%. These studies assumed CA to be the gold standard.…”

Section: Mra Of the Carotid Arterymentioning

confidence: 99%

Magnetic Resonance Angiography

Yucel¹,

Anderson²,

Edelman³

et al. 1999

Circulation

125

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Blinded-reader comparison of magnetic resonance angiography and duplex ultrasonography for carotid artery bifurcation stenosis.

Cited by 111 publications

References 31 publications

Critical Appraisal of the Design and Reporting of Studies of Imaging and Measurement of Carotid Stenosis

Critical Appraisal of the Design and Reporting of Studies of Imaging and Measurement of Carotid Stenosis

Role of Conventional Angiography in Evaluation of Patients With Carotid Artery Stenosis Demonstrated by Doppler Ultrasound in General Practice

Magnetic Resonance Angiography

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