Magnetic resonance angiography of the carotid arteries using three different techniques: accuracy compared with intraarterial x-ray angiography and endarterectomy specimens.
OBJECTIVE
To compare three different magnetic resonance angiography (MRA) techniques with x-ray angiography and endarterectomy specimens.


METHODS
Twenty-one patients underwent x-ray angiography, three-dimensional time-of-flight (TOF) focusing on the carotid bifurcation, high-resolution (HR) contrast-enhanced (CE) MRA, and time-resolved CE MRA. Stenoses of internal carotid arteries were evaluated by three independent observers on identical projection of x-ray angiography and MRA. Maximum stenosis grades on MRA were assessed additionally and correlated with endarterectomy specimens in 12 cases.


RESULTS
Sensitivity for the detection of severe stenoses was excellent (100%) for all MRA techniques, and specificity was superior for three-dimensional TOF (96.7%) compared with HR CE MRA (80.6%) and time-resolved CE MRA (83.9%). The correlation between x-ray angiography and MRA for all stenoses was slightly superior for three-dimensional TOF and HR CE MRA compared with the time-resolved technique (kappa = 0.87 and 0.86 vs. 0.84). The same trend was seen for the interobserver agreement and for the correlation with endarterectomy specimens. Eleven up to 17 stenoses (depending on the MRA technique) were graded higher using additional projections.


CONCLUSIONS
Three-dimensional TOF MRA yielded even more accurate results than HR CE MRA in grading of stenoses near the carotid bifurcation. Therefore, a combination of both methods seems to be advantageous.
Fellner
Claudia
C
Institute of Diagnostic Radiology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany. claudia.fellner@gespag.at
Lang
Werner
W
Janka
Rolf
R
Wutke
Ralf
R
Bautz
Werner
W
Fellner
Franz A
FA
D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D016893:Carotid Stenosis / Q000175:diagnosis; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012680:Sensitivity and Specificity