title: Contrast-enhanced magnetic resonance angiography of carotid arteries: utility in routine clinical practice.
abstract: OBJECTIVE
  Contrast-enhanced magnetic resonance angiography (CEMRA) is among the newer noninvasive tests used for the evaluation of patients with carotid artery disease. Evidence supporting its utility in routine clinical practice is lacking.
  
  
  METHODS
  The results of CEMRA were compared with those of catheter angiography in 50 consecutive patients being evaluated for carotid endarterectomy (CEA) at a community hospital. Using indications for CEA based on published guidelines, we determined the rate of misclassification for surgery, sensitivity, specificity, and positive and negative predictive values. In addition, the interrater agreement (kappa score) of CEMRA was compared with that of catheter angiography in the studied population and with interpretations provided by 2 blinded radiologists.
  
  
  RESULTS
  Compared with catheter angiography, 24% (95% CI, 12% to 36%) of patients would have been misclassified for CEA on the basis of CEMRA results alone. CEMRA was associated with sensitivity of 92%, specificity of 62%, positive predictive value of 78%, and negative predictive value of 89%. When both CEMRA and duplex Doppler ultrasound were performed and the results were concordant, the misclassification rate decreased to 17% (95% CI, 2% to 32%). kappa scores were similar for CEMRA and catheter angiography (0.72 and 0.75, respectively).
  
  
  CONCLUSIONS
  CEMRA was found to be highly sensitive for detection of surgically amenable carotid stenosis. kappa scores for the interpretation of CEMRA and catheter angiography were similar. However, clinicians should be cautious when using CEMRA alone for surgical decision making in CEA candidates because a significant number of patients may be misclassified. The rate of misclassification is reduced when the results of CEMRA and duplex Doppler ultrasound are concordant.
authors.affiliation: Department of Medicine (Neurology), University of British Columbia, Center for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada. dccj@interchange.ubc.ca
authors.forename: Dean C C
authors.initials: DC
authors.lastname: Johnston
authors.forename: James D
authors.initials: JD
authors.lastname: Eastwood
authors.forename: Thanh
authors.initials: T
authors.lastname: Nguyen
authors.forename: Larry B
authors.initials: LB
authors.lastname: Goldstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000601:surgery; D002340:Carotid Artery Diseases / Q000145:classification* / Q000175:diagnosis* / Q000601:surgery; D002404:Catheterization; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D018579:Patient Selection; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018616:Ultrasonography, Doppler, Duplex