title: Preliminary experience with MRA in evaluating the degree of carotid stenosis and plaque morphology using high-resolution sequences after gadofosveset trisodium (Vasovist) administration: comparison with CTA and DSA.
abstract: OBJECTIVE
  The authors performed a preliminary study with blood-pool contrast-enhanced magnetic resonance angiography (MRA) in evaluating the degree of carotid artery stenosis and plaque morphology, comparing the diagnostic performance of first-pass (FP) and steady-state (SS) acquisitions with 64-slice computed tomography angiography (CTA) and using digital subtraction angiography (DSA) as the reference standard.
  
  
  METHODS
  Twenty patients with >or=50% carotid artery stenosis at Doppler sonography underwent blood-pool contrast-enhanced MRA, CTA and DSA. Two independent radiologists evaluated MRA and CTA examinations to assess the degree of stenosis and characterise plaque morphology. Accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for FP, SS and CTA. The McNemar and Wilcoxon tests were used to determine significant differences (p<0.05) between the diagnostic performance of the three modalities.
  
  
  RESULTS
  Forty carotid bifurcations were studied. For stenosis grading, accuracy, sensitivity, specificity, PPV and NPV were 90%, 89%, 90%, 89% and 90%, respectively, at FP; 95%, 95%, 95%, 95% and 95%, respectively, at SS; and 97.5%, 95%, 100%, 100% and 95%, respectively, at CTA. SS and CTA were superior to FP for evaluating the degree of stenosis (p<0.05). For evaluating plaque morphology, accuracy, sensitivity, specificity, PPV and NPV were 87.5%, 89%, 86%, 85% and 90%, respectively, at FP; 97.5%, 100%, 95%, 95% and 100%, respectively, at SS; and 100%, 100%, 100%, 100% and 100%, respectively, at CTA. There were no significant differences between FP, SS and CTA for plaque assessment (p>0.05).
  
  
  CONCLUSIONS
  Blood-pool contrast-enhanced MRA with SS sequences allow improved diagnostic evaluation of the degree of carotid stenosis and plaque morphology compared with FP and is substantially equal to CTA and DSA.
authors.affiliation: Department of Radiological Sciences, University of Rome La Sapienza, V.le R. Elena 324, 00161, Rome, Italy. michele.anzidei@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Anzidei
authors.forename: A
authors.initials: A
authors.lastname: Napoli
authors.forename: D
authors.initials: D
authors.lastname: Geiger
authors.forename: B
authors.initials: B
authors.lastname: Cavallo Marincola
authors.forename: C
authors.initials: C
authors.lastname: Zini
authors.forename: F
authors.initials: F
authors.lastname: Zaccagna
authors.forename: P
authors.initials: P
authors.lastname: Di Paolo
authors.forename: C
authors.initials: C
authors.lastname: Catalano
authors.forename: R
authors.initials: R
authors.lastname: Passariello
mesh_terms: D000792:Angiography / Q000379:methods; D015901:Angiography, Digital Subtraction; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media; D005682:Gadolinium; D006801:Humans; D018810:Magnetic Resonance Angiography; D009942:Organometallic Compounds; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D005682:Gadolinium; C109932:gadofosveset trisodium