title: Contrast-enhanced three-dimensional magnetic resonance angiography of atherosclerotic internal carotid stenosis as the noninvasive imaging modality in revascularization decision making.
abstract: OBJECTIVE
  In patients with severe internal carotid artery stenoses, thromboendarterectomy significantly reduces both ischemic stroke and the risk of more ischemic attacks. Digital subtraction angiography (DSA) is the accepted preoperative test to determine whether a high-grade stenosis is present and requires surgical therapy. However, DSA has a procedural risk of stroke between 0.7% and 1%. An accurate, noninvasive imaging protocol with no risk of severe complications would significantly increase the benefit of surgical treatment. The aims of the study were (1) to evaluate the diagnostic accuracy of contrast-enhanced magnetic resonance angiography (CEMRA) in detecting and grading internal carotid artery stenoses and (2) to assess the misclassification rate of vessels suitable for revascularization by CEMRA.
  
  
  METHODS
  Ninety-two patients with sonographic evidence of neck vessel stenosis were enrolled in the study. All patients were submitted to CEMRA and DSA. CEMRA images were evaluated for the presence of mild, moderate, or severe stenosis and occlusion.
  
  
  RESULTS
  Sensitivity, specificity, and diagnostic accuracy were 97%, 82%, and 92.5%, respectively. Agreement with DSA was optimal at kappa=0.87. The misclassification rate of CEMRA was 3.1% because of its tendency to overestimate the stenosis.
  
  
  CONCLUSIONS
  The high diagnostic accuracy and limited misclassification rate suggest that CEMRA can be considered a powerful tool for the preoperative, noninvasive evaluation of atherosclerotic pathology of carotid arteries.
authors.affiliation: Department of Neuroscience, University of Pisa, Via Roma n 67, Pisa, Italy 56100. mircocosottini@hotmail.com
authors.forename: Mirco
authors.initials: M
authors.lastname: Cosottini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pingitore
authors.forename: Michele
authors.initials: M
authors.lastname: Puglioli
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Michelassi
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Lupi
authors.forename: Arturo
authors.initials: A
authors.lastname: Abbruzzese
authors.forename: Rosa
authors.initials: R
authors.lastname: Calabrese
authors.forename: Massimo
authors.initials: M
authors.lastname: Lombardi
authors.forename: Giuliano
authors.initials: G
authors.lastname: Parenti
authors.forename: Carlo
authors.initials: C
authors.lastname: Bartolozzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D002343:Carotid Artery, Internal / Q000601:surgery; D016893:Carotid Stenosis / Q000145:classification / Q000175:diagnosis* / Q000601:surgery; D003287:Contrast Media; D004691:Endarterectomy; D004869:Equipment Safety; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007089:Image Enhancement; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D018579:Patient Selection; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media