NDLI: MR angiography at 3 Tesla to assess proximal internal carotid artery stenoses: contrast-enhanced or 3D time-of-flight MR angiography?

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MR angiography at 3 Tesla to assess proximal internal carotid artery stenoses: contrast-enhanced or 3D time-of-flight MR angiography?

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MR angiography at 3 Tesla to assess proximal internal carotid artery stenoses: contrast-enhanced or 3D time-of-flight MR angiography?

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Weber, J. Veith, P. Jung, B. Ihorst, G. Moske-Eick, O. Meckel, S. Urbach, H. Taschner, C. A.
Description	Country affiliation: Germany Author Affiliation: Weber J ( Department of Neuroradiology, Neurocentre, University Hospital Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany.)
Abstract	PURPOSE: The aim of this study was to compare the diagnostic accuracy of 3D time-of-flight (TOF-MRA) and contrast-enhanced (CE-MRA) magnetic resonance angiography at 3 T for detection and quantification of proximal high-grade stenosis using multidetector computed tomography angiography (MDCTA) as reference standard. METHODS: The institutional ethics committee approved this prospective study. A total of 41 patients suspected of having internal carotid artery (ICA) stenosis underwent both MDCTA and MRA. CE-MRA and TOF-MRA were performed using a 3.0-T imager with a dedicated eight-element cervical coil. ICA stenoses were measured according to the North American Symptomatic Carotid Endarterectomy Trial criteria and categorized as 0-25 % (minimal), 25-50 % (mild), 50-69 % (moderate), 70-99 % (high grade), and 100 % (occlusion). Sensitivity and specificity for the detection of high-grade ICA stenoses (70-99 %) and ICA occlusions were determined. In addition, intermodality agreement was assessed with κ-statistics for detection of high-grade ICA stenoses (70-99 %) and ICA occlusions. RESULTS: A total of 80 carotid arteries of 41 patients were reviewed. Two previously stented ICAs were excluded from analysis. On MDCTA, 7 ICAs were occluded, 12 ICAs presented with and 63 without a high-grade ICA stenosis (70-99 %). For detecting 70-99 % stenosis, both 3D TOF-MRA and CE-MRA were 91.7 % sensitive and 98.5 % specific, respectively. Both MRA techniques were highly sensitive (100 %), and specific (CE-MRA, 100 %; TOF-MRA, 98.7 %) for the detection of ICA occlusion. However, TOF-MRA misclassified one high-grade stenosis as occlusion. Intermodality agreement for detection of 70-99 % ICA stenoses was excellent between TOF-MRA and CE-MRA [κ = 0.902, 95 % confidence interval (CI) = 0.769-1.000], TOF-MRA and MDCTA (κ = 0.902, 95 % CI = 0.769-1.000), and CE-MRA and MDCTA (κ = 0.902, 95 % CI = 0.769-1.000). CONCLUSION: Both 3D TOF-MRA and CE-MRA at 3 T are reliable tools for detecting high-grade proximal ICA stenoses (70-99 %). 3D TOF-MRA might misclassify pseudo-occlusions as complete occlusions. If there are no contraindications for CE-MRA, CE-MRA is recommended as primary MR imaging modality.
File Format	HTM / HTML
ISSN	18691439
Issue Number	1
Volume Number	25
e-ISSN	18691447
Journal	Clinical Neuroradiology
Language	English
Publisher	Springer
Publisher Date	2015-03-01
Publisher Place	Germany
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Neurology Discipline Radiology Carotid Stenosis Diagnosis Image Enhancement Methods Imaging, Three-dimensional Magnetic Resonance Angiography Meglumine Analogs & Derivatives Multidetector Computed Tomography Organometallic Compounds Aged Aged, 80 And Over Contrast Media Female Humans Male Middle Aged Reproducibility Of Results Sensitivity And Specificity Comparative Study Journal Article
Content Type	Text
Resource Type	Article
Subject	Radiology, Nuclear Medicine and Imaging Neurology (clinical)

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