Asymmetry of intracranial internal carotid artery on 3D TOF MR angiography: a sign of unilateral extracranial stenosis.
The purpose of this case-control study was to determine whether an asymmetry of size of the intracranial internal carotid artery (ICA) on 3D time-of-flight MR angiography (MRA) is predictive of a high-grade cervical ICA stenosis. Ninety-six stroke/TIA consecutive patients were recruited for the study, of whom 32 had unilateral high-grade ICA stenosis (>or=70% NASCET) and were included into the case group, and the remaining 64 did not have such high-grade stenosis and were included in the control group. On intracranial MRA, two observers, blinded to the characteristics of cervical ICA stenosis, independently searched for qualitative size asymmetry between ICAs and measured the cross-sectional surface of the intracranial ICAs. An intracranial size asymmetry was seen in 28 of the 32 high-grade stenoses by both readers, and in 10 (reader(1)) and 8 (reader(2)) of the 64 controls (sensitivity =88%, specificity =84-88%). In patients without agenesia of the A1 segment of the circle of Willis (n=70), sensitivity was >or=90% and specificity =96%. Surfaces ratios were significantly different (p<0.001) between cases and controls. However, using ROC curves analysis, the quantitative processing did not improve the detection when compared with the qualitative assessment of intracranial ICA asymmetry. A size asymmetry of the intracranial ICAs reveals the presence of an underlying high-grade cervical stenosis, with a high degree of confidence, especially in patients without anatomical variant of the anterior part of the circle of Willis. This sign may allow an early detection of high-grade cervical carotid stenosis in stroke patients before dedicated neck imaging is performed.
Naggara
Olivier
O
Faculté de Médecine René Descartes, Université Paris 5. Centre Hospitalier Sainte-Anne, Department of Neuroradiology, 1 rue Cabanis, 75674 Paris cedex 14, France.
Touzé
Emmanuel
E
Seiller
Nicolas
N
Gobin-Metteil
Marie-Pierre
MP
Mas
Jean-Louis
JL
Meder
Jean-François
JF
Oppenheim
Catherine
C
D000368:Aged; D002343:Carotid Artery, Internal / Q000002:abnormalities*; D016893:Carotid Stenosis / Q000175:diagnosis*; D016022:Case-Control Studies; D002533:Cerebral Angiography / Q000379:methods*; D016009:Chi-Square Distribution; D003287:Contrast Media; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008536:Meglumine; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
D003287:Contrast Media; D009942:Organometallic Compounds; D008536:Meglumine; C072417:gadoterate meglumine