title: Gadofosveset-enhanced MR angiography of carotid arteries: does steady-state imaging improve accuracy of first-pass imaging? Comparison with selective digital subtraction angiography.
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy of gadofosveset-enhanced magnetic resonance (MR) angiography in the assessment of carotid artery stenosis, with digital subtraction angiography (DSA) as the reference standard, and to determine the value of reading first-pass, steady-state, and "combined" (first-pass plus steady-state) MR angiograms.
  
  
  METHODS
  This study was approved by the local ethics committee, and all subjects gave written informed consent. MR angiography and DSA were performed in 84 patients (56 men, 28 women; age range, 61-76 years) with carotid artery stenosis at Doppler ultrasonography. Three readers reviewed the first-pass, steady-state, and combined MR data sets, and one independent observer evaluated the DSA images to assess stenosis degree, plaque morphology and ulceration, stenosis length, and tandem lesions. Interobserver agreement regarding MR angiographic findings was analyzed by using intraclass correlation and Cohen kappa coefficients. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated by using the McNemar test to determine possible significant differences (P < .05).
  
  
  RESULTS
  Interobserver agreement regarding all MR angiogram readings was substantial. For grading stenosis, sensitivity, specificity, PPV, and NPV were, respectively, 90%, 92%, 91%, and 91% for first-pass imaging; 95% each for steady-state imaging; and 96%, 99%, 99%, and 97% for combined imaging. For evaluation of plaque morphology, respective values were 84%, 86%, 88%, and 82% for first-pass imaging; 98%, 97%, 98%, and 97% for steady-state imaging; and 98%, 100%, 100%, and 97% for combined imaging. Differences between the first-pass, steady-state, and combined image readings for assessment of stenosis degree and plaque morphology were significant (P < .001).
  
  
  CONCLUSIONS
  Gadofosveset-enhanced MR angiography is a promising technique for imaging carotid artery stenosis. Steady-state image reading is superior to first-pass image reading, but the combined reading protocol is more accurate.
authors.affiliation: Department of Radiological Sciences, University of Rome La Sapienza, Viale Regina Elena 324, 00161 Rome, Italy. michele.anzidei@gmail.com
authors.forename: Michele
authors.initials: M
authors.lastname: Anzidei
authors.forename: Alessandro
authors.initials: A
authors.lastname: Napoli
authors.forename: Beatrice Cavallo
authors.initials: BC
authors.lastname: Marincola
authors.forename: Italo
authors.initials: I
authors.lastname: Nofroni
authors.forename: Daniel
authors.initials: D
authors.lastname: Geiger
authors.forename: Fulvio
authors.initials: F
authors.lastname: Zaccagna
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
authors.forename: Roberto
authors.initials: R
authors.lastname: Passariello
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D016893:Carotid Stenosis / Q000175:diagnosis*; D003287:Contrast Media; D005260:Female; D005682:Gadolinium; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D005682:Gadolinium; C109932:gadofosveset trisodium