title: Contrast-enhanced MR angiography is not more accurate than unenhanced 2D time-of-flight MR angiography for determining > or = 70% internal carotid artery stenosis.
abstract: OBJECTIVE
  Internal carotid artery (ICA) atheromatous disease is an important cause of ischemic stroke, and endarterectomy or stent placement is typically indicated for symptomatic patients with > or = 70% stenosis. Our purpose was to compare contrast-enhanced MR angiography (CE-MRA) with unenhanced 2D time-of-flight MR angiography (2D TOF MRA) in detecting hemodynamically significant ICA stenosis, by using CT angiography (CTA) as the reference standard.
  
  
  METHODS
  This was an institutional review board-approved retrospective study. We identified 177 consecutive patients (354 ICAs) who received correlative CE-MRA, 2D TOF MRA, and CTA. Two neuroradiologists blinded to the CTA data graded the degree of ICA stenosis according to a 5-point scale. Additionally, luminal signal-intensity characteristics including 1) signal intensity drop-out, 2) distal-vessel narrowing, and 3) distal-vessel signal-intensity reduction were recorded. MRA results were correlated with those of CTA, and receiver-operating-characteristic (ROC) curves were constructed.
  
  
  RESULTS
  On CTA, there were 55 ICAs with and 299 without > or = 70% stenosis. CE-MRA was 84% sensitive and 96% specific for detecting > or = 70% stenosis; 2D TOF MRA was 80% sensitive and 95% specific. The area under the ROC curve was 0.97 for CE-MRA and 0.95 for 2D TOF MRA (P = .51, not significant). For both MRA studies, each of the luminal signal-intensity characteristics had high specificity (> 98%) but poor-to-mild sensitivity (35%-66%) in detecting > or = 70% stenosis.
  
  
  CONCLUSIONS
  Although it is established that CE-MRA more accurately delineates neurovascular anatomy than does unenhanced 2D TOF MRA, the administration of gadolinium did not offer a significant advantage in distinguishing surgically treatable ICA stenosis. This conclusion may be important in patients with contraindications to gadolinium.
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass. 02114, USA.
authors.forename: L S
authors.initials: LS
authors.lastname: Babiarz
authors.forename: J M
authors.initials: JM
authors.lastname: Romero
authors.forename: E K
authors.initials: EK
authors.lastname: Murphy
authors.forename: B
authors.initials: B
authors.lastname: Brobeck
authors.forename: P W
authors.initials: PW
authors.lastname: Schaefer
authors.forename: R G
authors.initials: RG
authors.lastname: González
authors.forename: M H
authors.initials: MH
authors.lastname: Lev
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002343:Carotid Artery, Internal / Q000473:pathology; D016893:Carotid Stenosis / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D005682:Gadolinium; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods* / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012372:ROC Curve; D012015:Reference Standards; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D003287:Contrast Media; D005682:Gadolinium