Contrast-enhanced three-dimensional magnetic resonance angiography of atherosclerotic internal carotid stenosis as the noninvasive imaging modality in revascularization decision making.
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.
Cosottini
Mirco
M
Department of Neuroscience, University of Pisa, Via Roma n 67, Pisa, Italy 56100. mircocosottini@hotmail.com
Pingitore
Alessandro
A
Puglioli
Michele
M
Michelassi
Maria Chiara
MC
Lupi
Giancarlo
G
Abbruzzese
Arturo
A
Calabrese
Rosa
R
Lombardi
Massimo
M
Parenti
Giuliano
G
Bartolozzi
Carlo
C
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
D003287:Contrast Media