Carotid artery stenosis: clinical efficacy of two-dimensional time-of-flight MR angiography.

Heiserman, Joseph E.; Drayer, Burton P.; Fram, Evan K.; Keller, Paul J.; Bird, C R; Hodak, J A; Flom, Richard A.

doi:10.1148/radiology.182.3.1535891

Cited by 120 publications

(46 citation statements)

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“…The 2D TOF technique is commonly used for imaging vessels with preferentially perpendicular flow and relatively fast velocity like peripheral (41) and carotid (43) arteries. It has been demonstrated for the evaluation of stenosis in tibial and pedal arteries (41).…”

Section: Applicationsmentioning

confidence: 99%

Non‐contrast enhanced MR angiography: Physical principles

Wheaton

Miyazaki

2012

Magnetic Resonance Imaging

136

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Noncontrast‐enhanced magnetic resonance angiography (NCE‐MRA) methods have been demonstrated in anatomies throughout the body. Previously established NCE‐MRA techniques suffered from long scan times or low sensitivity. Advances in hardware and software have made NCE‐MRA scan times clinically feasible. Recent concerns over the safety of gadolinium‐based contrast material combined with the expense of the material and its administration have generated a demand for NCE‐MRA. In response, several new NCE‐MRA methods have been developed. The physical mechanisms underlying five general classes of NCE‐MRA methods (inflow effect, flow‐dependency on cardiac phase, flow‐encoding, spin labeling, and relaxation) are explained. The original techniques of time‐of‐flight (TOF) and phase contrast MRA (PC‐MRA) are briefly introduced. New developments in NCE‐MRA, including hybrid of opposite‐contrast (HOP‐MRA), four dimensional PC‐MRA (4D Flow), cardiac‐gated 3D fast‐spin‐echo, flow‐sensitive dephasing (FSD), arterial spin labeling (ASL), and balanced steady‐state free‐precession (bSSFP) are highlighted. The primary applications, advantages, and limitations of established and emerging NCE‐MRA techniques are discussed. J. Magn. Reson. Imaging 2012;36:286–304. © 2012 Wiley Periodicals, Inc.

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Section: Applicationsmentioning

confidence: 99%

Non‐contrast enhanced MR angiography: Physical principles

Wheaton

Miyazaki

2012

Magnetic Resonance Imaging

136

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“…Sensitivity of MRA in detecting carotid stenosis ranges between 75% and 100%; specificity ranges between 59% and 99%. 4,5 The main pitfall of this technique remains the overestimation of high-grade stenosis resulting from intravoxel phase dispersion in cases of turbulent flow. 6 The advent of contrast-enhanced MRA (CEMRA) has dramatically improved the diagnostic accuracy of MRA in many vascular areas.…”

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confidence: 99%

Contrast-Enhanced Three-Dimensional Magnetic Resonance Angiography of Atherosclerotic Internal Carotid Stenosis as the Noninvasive Imaging Modality in Revascularization Decision Making

Cosottini

Pingitore

Puglioli

et al. 2003

Stroke

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Background and Purpose-In patients with severe internal carotid artery stenoses, thromboendarterectomy significantly reduces both ischemic stroke and the risk of more ischemic attacks. Digital subtraction angiography (DSA) is the accepted preoperative test to determine whether a high-grade stenosis is present and requires surgical therapy. However, DSA has a procedural risk of stroke between 0.7% and 1%. An accurate, noninvasive imaging protocol with no risk of severe complications would significantly increase the benefit of surgical treatment. The aims of the study were (1) to evaluate the diagnostic accuracy of contrast-enhanced magnetic resonance angiography (CEMRA) in detecting and grading internal carotid artery stenoses and (2) to assess the misclassification rate of vessels suitable for revascularization by CEMRA. Methods-Ninety-two patients with sonographic evidence of neck vessel stenosis were enrolled in the study. All patients were submitted to CEMRA and DSA. CEMRA images were evaluated for the presence of mild, moderate, or severe stenosis and occlusion. Results-Sensitivity, specificity, and diagnostic accuracy were 97%, 82%, and 92.5%, respectively. Agreement with DSA was optimal at ϭ0.87. The misclassification rate of CEMRA was 3.1% because of its tendency to overestimate the stenosis. Conclusions-The high diagnostic accuracy and limited misclassification rate suggest that CEMRA can be considered a powerful tool for the preoperative, noninvasive evaluation of atherosclerotic pathology of carotid arteries.

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“…A number of other studies evaluating the 2D TOF technique failed to use multiple independent blinded readers 13, 16, 35 Many also did not explicitly use direct measurement of MRA and arteriographic stenoses, which can potentially lead to misclassification of stenoses as greater or less than 70% in a significant proportion of cases. 37 One study evaluated a small proportion of vessels with disease 15 : of 73 vessels, fewer than 10 had surgical disease (denned as 76% to 99% stenosis). This study does not suffer from these shortcomings because we used three blinded readers in assessing the MRAs, directly measured stenoses on MRA and arteriography, and had a wide range of vessel stenoses, with 22 of 73 vessels demonstrating surgical (70% to 99%) stenoses on arteriography.…”

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confidence: 99%

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

Mittl

Broderick

Carpenter

et al. 1994

Stroke

110

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Background and PurposeWe compared two-dimensional time-of-flight magnetic resonance angiography (MRA) and duplex ultrasonography with arteriography for the detection of 70% to 99% stenoses at the carotid artery bifurcation (ie, surgical disease according to findings of the North American Carotid Endarterectomy Trial).Methods Three blinded readers independently measured stenoses on MRA in 73 vessels from 38 patients. Duplex ultrasonography was available in 66 vessels from 35 of these patients, and blinded reading was performed by one reader. Comparison was made to arteriography.Results Magnetic resonance angiography demonstrated a sensitivity of 92.4%, specificity of 74.5%, and negative predictive value of 95.8% for 70% to 99% stenoses. Interobserver agreement was high (K=0.91). Absence of signal at stenoses with evidence of distal flow usually, but not always, corresponded to surgical disease. Duplex ultrasonography demonstrated a sensitivity of 81.0%, specificity of 82.2%, and negative predictive value of 90.2% for surgical disease. There was

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Carotid artery stenosis: clinical efficacy of two-dimensional time-of-flight MR angiography.

Cited by 120 publications

References 0 publications

Non‐contrast enhanced MR angiography: Physical principles

Non‐contrast enhanced MR angiography: Physical principles

Contrast-Enhanced Three-Dimensional Magnetic Resonance Angiography of Atherosclerotic Internal Carotid Stenosis as the Noninvasive Imaging Modality in Revascularization Decision Making

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

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