Concordance Rate Differences of 3 Noninvasive Imaging Techniques to Measure Carotid Stenosis in Clinical Routine Practice

Abstract

Background and Purpose-To replace digital subtraction angiography (DSA) in carotid stenosis evaluation, noninvasive imaging techniques have to reach a high concordance rate. Our purpose is to compare the concordance rates of contrast-enhanced MR angiography (CEMRA) and CT angiography (CTA) with Doppler ultrasound (DUS) in clinical routine practice. Methods-We evaluated prospectively with DUS, CEMRA, and CTA 150 patients suspected of carotid stenosis. The overall concordance rates of the 3 techniques were calculated for symptomatic stenosis Ն50% and Ն70%, for asymptomatic stenosis Ն60%, and for occlusion. For the carotid arteries treated by surgery (nϭ97), the results of each method and combined techniques were recorded, and misclassification rates were evaluated from surgical reports. Results-The overall concordance rates of DUS-CEMRA, DUS-CTA, and CEMRA-CTA were not statistically different.However, the concordance rate of DUS-CEMRA (92.53%) was significantly higher than that for DUS-CTA (79.10%) in the surgical asymptomatic stenosis group (Pϭ0.0258). CTA considered alone would misclassify the stenosis in a significant number of cases (11 of 64) in the surgical asymptomatic group compared with CEMRA (3 of 67) and DUS (1 of 66) (Pϭ0.0186 versus MRA, Pϭ0.0020 versus DUS). Conclusions-With the techniques as utilized in our study, the overall concordance rates of combined noninvasive methods are similar for measuring carotid stenosis in clinical routine practice, but in asymptomatic carotid stenosis, the decision making for surgery is significantly altered if DUS and CTA are considered in place of DUS and CEMRA.

Use of Magnetic Resonance Imaging to Predict Outcome after Stroke: A Review of Experimental and Clinical Evidence

“…Imaging methods, such as ultrasound, can be preferred. Magnetic resonance angiography has been shown to be comparable and even superior to ultrasound for evaluating vessel stenosis (Nonent et al, 2004). In addition to TOF-MRA where blood flow is visualized noninvasively with short TR images, contrast-enhanced MRA (CE-MRA) is also routinely used.…”

Comparison of Blood Flow Velocity Quantification by 4D Flow MR Imaging with Ultrasound at the Carotid Bifurcation

“…2,3 A recent meta-analysis revealed a pooled sensitivity and specificity of CE-MRA of ca. 94% and 93%, respectively, indicating that accuracy is lower compared with DSA and US.…”

“…2 In contrast to angiography, US provides limited morphologic information but detailed information regarding velocities at the carotid bifurcation and intracranial collateral blood flow. 3,4 A combination of such information as one 3D dataset provided by 1 technique (eg, CE-MRA plus PC MR imaging), would allow for a comprehensive assessment of the carotid bifurcation. Accordingly, carotid artery blood flow could be determined by use of time-resolved 2D PC MR imaging.…”

Abklärung von Karotis-Stenose und -verschluss

“…Die ersten drei Studien, die bei Patienten mit asymptomatischer Karotisstenose die CEA mit einer konservativen Behandlung verglichen, zeigten keine Abnahme der Schlaganfälle in der operierten Gruppe [20,21], und die «Mayo Asymptomatic Carotid Endarterectomy Study» wurde nach 71 Patienten gestoppt [22]. Die «Asymptomatic Carotid Atherosclerosis Study» (ACST) [23] [54,55,58,[65][66][67]. In einer Arbeit konnte gezeigt werden, dass das CTA zuverlässig subtotale Karotisstenosen mit distal engem Lumen erfassen kann (Abb.…”