Magnetic resonance angiography, digital subtraction angiography and Doppler ultrasonography in detection of carotid artery stenosis: a comparison with findings from histological specimens

Netuka, David; Ostrý, Svatopluk; Belšán, T.; Ručka, David; Mandys, Václav; Charvát, František; Bradáč, Ondřej; Beneš, Vladimı́r

doi:10.1007/s00701-010-0645-2

Cited by 15 publications

(8 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous results have indicated that CDUS evaluations generally overestimate the degree of stenosis (23). In the current study, some false-positive results were generated by CDUS, possibly due to differences in the imaging principles for CDUS and DSA.…”

Section: Degree Of Degree Of Stenosis By Dsa Stenosis ---------------mentioning

confidence: 47%

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

View full text Add to dashboard Cite

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 ...

show abstract

Section: Degree Of Degree Of Stenosis By Dsa Stenosis ---------------mentioning

confidence: 47%

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

View full text Add to dashboard Cite

show abstract

“…Recent literature and the current study, however, suggest that DSA may incorrectly estimate true stenosis when its findings are compared with those of other imaging modalities as well as measurements in histological specimens. 5,17,26 Although these studies were conducted in the extracranial carotid artery, this body of evidence raises a question about the validity of what is considered our gold standard. DSA may not provide an optimal assessment of plaque stenosis and morphology in ICAD.…”

Section: Discussionmentioning

confidence: 99%

Superior performance of cone-beam CT angiography in characterization of intracranial atherosclerosis

Safain¹,

Rahal²,

Patel³

et al. 2014

JNS

View full text Add to dashboard Cite

Object. Intracranial atherosclerotic disease (ICAD) carries a high risk of stroke. Evaluation of ICAD has focused on assessing the absolute degree of stenosis, although plaque morphology has recently demonstrated increasing relevance. The authors provide the first report of the use of ultra-high-resolution C-arm cone-beam CT angiography (CBCT-A) in the evaluation of vessel stenosis as well as plaque morphology.Methods. Between August 2009 and July 2012, CBCT-A was used in all patients with ICAD who underwent catheter-based angiography at the authors' institution (n = 18). Lesions were evaluated for maximum degree of stenosis as well as plaque morphological characteristics (ulcerated, calcified, dissected, or spiculated) via digital subtraction angiography (DSA), 3D-rotational angiography (3DRA), and CBCT-A. The different imaging modalities were compared in their assessment of absolute stenosis as well as their ability to resolve different plaque morphologies.Results. Lesions were found to have similar degrees of stenosis when utilizing CBCT-A compared with 3DRA, but both 3DRA and CBCT-A differed from DSA in their assessment of the absolute degree of stenosis. CBCT-A provided the most detailed resolution of plaque morphology, identifying a new plaque characteristic in 61% of patients (n = 11) when compared with DSA and 50% (n = 9) when compared with 3DRA. CBCT-A identified all lesion characteristics visualized on DSA and 3DRA.Conclusions. CBCT-A provides detailed spatial resolution of plaque morphology and may add to DSA and 3DRA in the evaluation of ICAD. Further prospective study is warranted to determine any benefit CBCTA-A may provide in clinical decision making and risk stratification over existing conventional imaging modalities. This article contains some figures that are displayed in color on line but in black-and-white in the print edition. M. G. Safain et al. 442J Neurosurg / Volume 121 / August 2014 cranial stent placement during aneurysm treatment, 20,22 and delineate cerebral 15,16 and spinal arteriovenous malformations.1 Furthermore, CBCT-A has since been shown to have excellent spatial resolution of the intracranial vasculature, including the ability to resolve submillimeter objects such as stent struts measuring 50-70 µm. 13Despite these uses of CBCT-A in evaluation of intracranial vessels, its utility in determining stenosis and plaque morphology in ICAD has not been previously evaluated.Given the high spatial resolution provided by CBCT-A, we have, since August 2009, obtained imaging studies in all patients undergoing catheter-based angiography for ICAD using this modality, in addition to contemporaneous standard DSA and 3DRA. We sought here to compare and quantify the resolution of CBCT-A compared with 3DRA as well as DSA in the evaluation of ICAD. We present the initial report of additional plaque characteristics identified by CBCT-A in patients with ICAD. Methods Case SelectionDuring the study time period of August 2009 to July 2012, all patients undergoing catheter-based angiography for the ...

show abstract

“…A study of 103 patients undergoing endarterectomy had their plaque sectioned transversally and assessed planimetrically. 13 All patients had preoperative catheter angiography and MRA. Overall, catheter angiography underestimated histological stenosis by 14.5%, whereas MRA underestimated histological stenosis by only 0.7%.…”

Section: Identifying and Characterizing Carotid Stenosismentioning

confidence: 99%

Evaluation and Management of Atherosclerotic Carotid Stenosis

Meschia

Klaas

Brown

et al. 2017

Mayo Clinic Proceedings

View full text Add to dashboard Cite

Medical therapies for the prevention of stroke have advanced considerably in the last several years. There can also be a role for mechanical restoration of the lumen by endarterectomy or stenting in selected patients with high-grade atherosclerotic stenosis of the extracranial carotid artery. Endarterectomy is generally recommended for patients with high-grade symptomatic carotid stenosis. Stenting is considered an option for patients at high risk of complications with endarterectomy. Whether revascularization is better than contemporary medical therapy for asymptomatic extracranial carotid stenosis is a subject of several ongoing randomized clinical trials in the United States and internationally.

show abstract

Magnetic resonance angiography, digital subtraction angiography and Doppler ultrasonography in detection of carotid artery stenosis: a comparison with findings from histological specimens

Cited by 15 publications

References 22 publications

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

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

Superior performance of cone-beam CT angiography in characterization of intracranial atherosclerosis

Evaluation and Management of Atherosclerotic Carotid Stenosis

Contact Info

Product

Resources

About