Contrast-enhanced MR angiography of the carotid and vertebrobasilar circulations.
OBJECTIVE
Contrast-enhanced MR angiography (CE MRA) is a proven diagnostic tool in evaluation of the carotid arteries; however, few studies have addressed its accuracy in the vertebrobasilar system. The purpose of this study was to assess the sensitivity and specificity of CE MRA compared with digital subtraction angiography (DSA) for detection of vertebrobasilar disease.


METHODS
Forty patients with suspected atherosclerotic disease of the carotid and vertebrobasilar circulations underwent CE MRA on a 1.5 T MR imaging scanner by use of a coronal 3D gradient-echo pulse sequence after intravenous injection of gadolinium diethylene triamine penta-acetic acid. All patients had correlative DSA within a 1-month period. CE MRA images were randomized and then independently assessed by 2 observers who were blinded to the DSA results. DSA examinations were analyzed in a similar manner. Each observer was asked to report the presence or absence of clinically significant stenosis (>50%), occlusion, fistula, aneurysm, and dissection. The MRA findings were then correlated with DSA.


RESULTS
The sensitivity and specificity of MRA for detection of disease in the entire carotid and vertebrobasilar systems were 90% and 97%, respectively; for the carotid system alone, the sensitivity and specificity were 94% and 97%, respectively; and for the vertebrobasilar system they were 88% and 98% respectively. The overall interobserver reliability was 98% (kappa = 0.92).


CONCLUSIONS
CE MRA is accurate at detecting disease not only in the carotid vessels, but also in the vertebrobasilar circulation, and has the potential to provide a comprehensive and noninvasive evaluation of the head and neck arteries in a single study.
Yang
Carina W
CW
Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
Carr
James C
JC
Futterer
Stephen F
SF
Morasch
Mark D
MD
Yang
Benson P
BP
Shors
Stephanie M
SM
Finn
J Paul
JP
D000368:Aged; D015901:Angiography, Digital Subtraction / Q000592:standards; D002340:Carotid Artery Diseases / Q000175:diagnosis; D003287:Contrast Media; D017352:Echo-Planar Imaging / Q000592:standards*; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis*
D003287:Contrast Media; D019786:Gadolinium DTPA