Contrast-Enhanced Three-Dimensional Magnetic Resonance Angiography of Atherosclerotic Internal Carotid Stenosis as the Noninvasive Imaging Modality in Revascularization Decision Making

Abstract

Background and Purpose-In patients with severe internal carotid artery stenoses, thromboendarterectomy significantly reduces both ischemic stroke and the risk of more ischemic attacks. Digital subtraction angiography (DSA) is the accepted preoperative test to determine whether a high-grade stenosis is present and requires surgical therapy. However, DSA has a procedural risk of stroke between 0.7% and 1%. An accurate, noninvasive imaging protocol with no risk of severe complications would significantly increase the benefit of surgical treatment. The aims of the study were (1) to evaluate the diagnostic accuracy of contrast-enhanced magnetic resonance angiography (CEMRA) in detecting and grading internal carotid artery stenoses and (2) to assess the misclassification rate of vessels suitable for revascularization by CEMRA. Methods-Ninety-two patients with sonographic evidence of neck vessel stenosis were enrolled in the study. All patients were submitted to CEMRA and DSA. CEMRA images were evaluated for the presence of mild, moderate, or severe stenosis and occlusion. Results-Sensitivity, specificity, and diagnostic accuracy were 97%, 82%, and 92.5%, respectively. Agreement with DSA was optimal at ϭ0.87. The misclassification rate of CEMRA was 3.1% because of its tendency to overestimate the stenosis. Conclusions-The high diagnostic accuracy and limited misclassification rate suggest that CEMRA can be considered a powerful tool for the preoperative, noninvasive evaluation of atherosclerotic pathology of carotid arteries.

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

“…265 Contrast-enhanced MRA is more accurate than nonenhanced TOF techniques, with specificities and sensitivities of 86% to 97% and 62% to 91%, respectively, compared with DSA. 320,[327][328][329][330][331][332] Craniocervical arterial dissections of the carotid and vertebral arteries can often be detected with MRA. [333][334][335][336] Contrast-enhanced MRA may improve the detection of arterial dissections, 337 although there are few large, prospective studies to prove its accuracy versus catheter angiography.…”

Diagnostic Accuracy of Magnetic Resonance Angiography for Internal Carotid Artery Disease

“…Of these papers, 37 TOF MRA 17,18,26 -60 and 21 CE MRA papers 16,26,27,33,35,37,[61][62][63][64][65][66][67][68][69][70][71][72][73][74][75] fulfilled the inclusion criteria (Tables 1 and 2). Of the TOF papers, 11 used 2D TOF MRA, 14 used 3D TOF MRA, and 12 included both 2D and 3D TOF data (Table 1).…”

Accurate, practical and cost-effective assessment of carotid stenosis in the UK

“…Only seven studies included some asymptomatic patients, but these studies fulfilled the inclusion criterion that at least 70% of the patients had to be symptomatic. 85,99,[105][106][107]116 Although many studies used more than one less invasive imaging method, it was not always possible to extract data on all techniques used, or at the stenosis cut-offs required for the metaanalysis. Thus more less invasive techniques are listed in Table 1 than contributed to the metaanalysis.…”