Critical review of non- or minimally invasive methods (duplex ultrasonography, MR- and CT-angiography) for evaluating stenosis of the proximal internal carotid artery.
OBJECTIVE
to assess the performance of non- or minimally invasive methods (duplex ultrasonography, MR- and CT-angiography) in measuring stenosis of the proximal internal carotid prior to endarterectomy without preoperative intra-arterial digital subtraction angiography (DSA).


METHODS
systematic review of the literature (five databases, 1990 to February 2001). The value of each imaging technique was studied through its reproducibility and its sensitivity/specificity compared to DSA.


RESULTS
sensitivity exceeded 80% and specificity 90% in over two-thirds of the methodologically sound studies, regardless of technique, although direct comparisons between results had to be avoided since the findings originated from different populations. The main drawback of duplex ultrasonography is its levels of reproducibility. In contrast, only a few studies have addressed the reproducibility of MR- and CT-angiography. When the results of duplex and MR-angiography agree, the combination use of these two techniques provides a better diagnosis than either technique taken alone.


CONCLUSIONS
all three techniques appear suitable for measuring stenosis of the proximal internal carotid when compared to DSA.
Long
A
A
Department of Cardiovascular Radiology, Hôpital Européen Georges Pompidou, Paris, France.
Lepoutre
A
A
Corbillon
E
E
Branchereau
A
A
D015901:Angiography, Digital Subtraction; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D016894:Endarterectomy, Carotid; D006801:Humans; D018810:Magnetic Resonance Angiography; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D018616:Ultrasonography, Doppler, Duplex