Eco-Doppler ed angio-RM nella valutazione della stenosi carotidea

D’Onofrio, Mirko; Mansueto, Giancarlo; Faccioli, Niccolò; Guarise, Alessandro; Tamellini, Paolo; Bogina, Giuseppe; Mucelli, Roberto Pozzi

doi:10.1007/s11547-006-0010-y

Cited by 17 publications

(8 citation statements)

References 27 publications

(88 reference statements)

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“…Sensitivity and specificity were also better with contrast-enhanced MRA using Gd-DOTA than TOF-MRA when evaluated at the segment level, and the technical failure rate for contrast-enhanced MRA using Gd-DOTA was substantially (and statistically significantly, p<0.0001) lower than for TOF-MRA. A number of published clinical studies have shown that MRA is as accurate as conventional (x-ray) intra-arterial digital subtraction angiography in clinical situations such as lower-extremity atherosclerotic occlusive disease or carotid artery stenosis [12][13][14]. In these and other studies, MRA has demonstrated similar sensitivity and specificity to conventional x-ray angiography, with a predicted lower cost and lower risk due to the absence of injected iodinated contrast and vessel catheterization (i.e., lower invasiveness) [15].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of contrast-enhanced magnetic resonance angiography (MRA) using Gd-DOTA compared with time-of-flight MRA in the diagnosis of clinically significant non-coronary arterial disease

Kang¹,

Lim

Choi³

et al. 2010

Eur Radiol

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Section: Discussionmentioning

confidence: 99%

Evaluation of contrast-enhanced magnetic resonance angiography (MRA) using Gd-DOTA compared with time-of-flight MRA in the diagnosis of clinically significant non-coronary arterial disease

Kang¹,

Lim

Choi³

et al. 2010

Eur Radiol

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“…A Class III study by D'Onofrio et al 61 prospectively evaluated 32 patients who either had carotid Doppler ultrasonography (DUS) or contrast-enhanced MRA and compared it to either digital subtraction angiography (DSA) or endarterectomy. Both had strong correlation in identifying stenosis, with both identifying 100% of surgical stenosis (defined as carotid stenosis of 60% to 99%).…”

Section: In Adult Patients Withmentioning

confidence: 99%

Clinical Policy: Critical Issues in the Evaluation of Adult Patients With Suspected Transient Ischemic Attack in the Emergency Department

Carpenter¹,

Wright²,

Brown³

et al. 2016

Annals of Emergency Medicine

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This clinical policy from the American College of Emergency Physicians addresses key issues for adults presenting to the emergency department with suspected transient ischemic attack. A writing subcommittee conducted a systematic review of the literature to derive evidence-based recommendations to answer the following clinical questions: (1) In adult patients with suspected transient ischemic attack, are there clinical decision rules that can identify patients at very low short-term risk for stroke who can be safely discharged from the emergency department? (2) In adult patients with suspected transient ischemic attack, what imaging can be safely delayed from the initial emergency department workup? (3) In adult patients with suspected transient ischemic attack, is carotid ultrasonography as accurate as neck computed tomography angiography or magnetic resonance angiography in identifying severe carotid stenosis? (4) In adult patients with suspected transient ischemic attack, can a rapid emergency department-based diagnostic protocol safely identify patients at short-term risk for stroke? Evidence was graded and recommendations were made based on the strength of the available data.

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“…With the development of noninvasive magnetic resonance techniques and imaging technology, the diagnostic values of magnetic resonance angiography (MRA) and Doppler ultrasound (DUS) in CS are a current focus of research. In the diagnosis of CS, the results of these noninvasive examination methods are consistent with those of DSA; therefore, MRA and DUS, as noninvasive screening methods, may be suitable replacements for DSA (9)(10)(11)(12) DUS (CDUS) in detecting the extent of CS remain to be determined by large scale studies.…”

Section: Introductionmentioning

confidence: 82%

Comparative analysis of 3D time-resolved contrast-enhanced magnetic resonance angiography, color Doppler ultrasound and digital subtraction angiography in symptomatic carotid stenosis

et al. 2017

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Abstract. The present study aimed to compare the diagnostic value of contrast-enhanced magnetic resonance angiography (CE MRA) with 3D time-resolved imaging of contrast kinetics, color Doppler ultrasound (CDUS) and digital subtraction angiography (DSA) in extracranial carotid stenosis (CS). A total of 54 patients with symptomatic CS were subjected to CDUS, CE MRA and DSA examination. Results of DSA were defined as the standard, and a total of 216 vessels were examined. In each patient four vessels were examined, namely the bilateral common carotid arteries and the bilateral internal carotid arteries. The sensitivities and specificities of CE MRA and CDUS for various degrees of CS were also determined. It was observed that the sensitivities to mild-level (1-49%), moderate-level (50-69%) and severe-level (70-99%) CS were 85.45, 100 and 100% for CE MRA, and 78.18, 50 and 100% for CDUS, respectively. The corresponding specificities were 95.27, 98.58 and 99.53% for CE MRA, and 79.05, 93.36 and 98.10% for CDUS, respectively. In addition, the carotid sinus plaque detection rate for CDUS was significantly higher than that of DSA and CE MRA (both P<0.001). Detection rates for common carotid artery plaques and internal carotid artery plaques did not significantly differ among the three examination methods (all P>0.05). These data demonstrate that CE MRA has higher sensitivity and specificity than CDUS for the diagnosis of CS, and that CDUS has a higher carotid sinus plaque detection rate than DSA and CE MRA. Therefore, the combination of MRI and CDUS may be a 'gold standard' diagnostic method for the detection of moderate and severe CS. IntroductionCarotid stenosis (CS) is a primary cause and risk factor of ischemic cerebrovascular disease. The most common location of CS is the carotid artery bifurcation, followed by the common carotid artery, the internal carotid artery siphon, middle cerebral artery and brain arteries (1). It is generally believed that carotid artery plaques are caused by one of two mechanisms: One is severe stenosis of the carotid artery causing hemodynamic changes and correspondingly low perfusion in parts of the brain. The other is that plaque in microemboli or patches on the surface of microthrombi fall off and cause cerebral embolism (2). Previous studies indicate that >60% of strokes are caused by carotid stenosis, and if serious these may lead to disability and even death in patients with cerebral apoplexy (3). The Society for Vascular Surgery recommends that, in patients with symptomatic CS, if noninvasive imaging identifies a stenosis degree of >70% (class I/level A), or if angiography identifies a stenosis degree of >50% (class I/level B), a carotid endarterectomy should be performed to reduce the risk of stroke (4). Thus, accurate assessment of the degree of CS is critical for the prevention of stroke (5). Digital subtraction angiography (DSA) is generally considered to be the gold standard for the diagnosis of CS. However, the rate of stroke induced by the invasive DSA procedure ranges from ...

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Eco-Doppler ed angio-RM nella valutazione della stenosi carotidea

Abstract: These data suggest that endarterectomy on the basis of Doppler US and CE-MRA can be considered appropriate. CEMRA was the best noninvasive imaging modality to detect plaque ulceration.

Cited by 17 publications

References 27 publications

Evaluation of contrast-enhanced magnetic resonance angiography (MRA) using Gd-DOTA compared with time-of-flight MRA in the diagnosis of clinically significant non-coronary arterial disease

Evaluation of contrast-enhanced magnetic resonance angiography (MRA) using Gd-DOTA compared with time-of-flight MRA in the diagnosis of clinically significant non-coronary arterial disease

Clinical Policy: Critical Issues in the Evaluation of Adult Patients With Suspected Transient Ischemic Attack in the Emergency Department

Comparative analysis of 3D time-resolved contrast-enhanced magnetic resonance angiography, color Doppler ultrasound and digital subtraction angiography in symptomatic carotid stenosis

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