title: Concordance rate differences of 3 noninvasive imaging techniques to measure carotid stenosis in clinical routine practice: results of the CARMEDAS multicenter study.
abstract: OBJECTIVE
  To replace digital subtraction angiography (DSA) in carotid stenosis evaluation, noninvasive imaging techniques have to reach a high concordance rate. Our purpose is to compare the concordance rates of contrast-enhanced MR angiography (CEMRA) and CT angiography (CTA) with Doppler ultrasound (DUS) in clinical routine practice.
  
  
  METHODS
  We evaluated prospectively with DUS, CEMRA, and CTA 150 patients suspected of carotid stenosis. The overall concordance rates of the 3 techniques were calculated for symptomatic stenosis > or =50% and > or =70%, for asymptomatic stenosis > or =60%, and for occlusion. For the carotid arteries treated by surgery (n=97), the results of each method and combined techniques were recorded, and misclassification rates were evaluated from surgical reports.
  
  
  RESULTS
  The overall concordance rates of DUS-CEMRA, DUS-CTA, and CEMRA-CTA were not statistically different. However, the concordance rate of DUS-CEMRA (92.53%) was significantly higher than that for DUS-CTA (79.10%) in the surgical asymptomatic stenosis group (P=0.0258). CTA considered alone would misclassify the stenosis in a significant number of cases (11 of 64) in the surgical asymptomatic group compared with CEMRA (3 of 67) and DUS (1 of 66) (P=0.0186 versus MRA, P=0.0020 versus DUS).
  
  
  CONCLUSIONS
  With the techniques as utilized in our study, the overall concordance rates of combined noninvasive methods are similar for measuring carotid stenosis in clinical routine practice, but in asymptomatic carotid stenosis, the decision making for surgery is significantly altered if DUS and CTA are considered in place of DUS and CEMRA.
authors.affiliation: Department of Radiology, University Hospital Center, Brest, France. michel.nonent@chu-brest.fr
authors.forename: Michel
authors.initials: M
authors.lastname: Nonent
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Serfaty
authors.forename: Norbert
authors.initials: N
authors.lastname: Nighoghossian
authors.forename: François
authors.initials: F
authors.lastname: Rouhart
authors.forename: Laurent
authors.initials: L
authors.lastname: Derex
authors.forename: Carmen
authors.initials: C
authors.lastname: Rotaru
authors.forename: Pierre
authors.initials: P
authors.lastname: Chirossel
authors.forename: Bruno
authors.initials: B
authors.lastname: Guias
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Heautot
authors.forename: Pierre
authors.initials: P
authors.lastname: Gouny
authors.forename: Bernard
authors.initials: B
authors.lastname: Langella
authors.forename: Valérie
authors.initials: V
authors.lastname: Buthion
authors.forename: Isabelle
authors.initials: I
authors.lastname: Jars
authors.forename: Chahin
authors.initials: C
authors.lastname: Pachai
authors.forename: Charles
authors.initials: C
authors.lastname: Veyret
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Gauvrit
authors.forename: Michel
authors.initials: M
authors.lastname: Lamure
authors.forename: Philippe C
authors.initials: PC
authors.lastname: Douek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007089:Image Enhancement; D018810:Magnetic Resonance Angiography / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014465:Ultrasonics; D014463:Ultrasonography