Stroke, Vol 25, 4-10, Copyright © 1994 by American Heart Association
RL Mittl Jr, M Broderick, JP Carpenter, HI Goldberg, J Listerud, MM Mishkin, HD Berkowitz and SW Atlas
BACKGROUND AND PURPOSE--We compared two-dimensional time-of-flight magnetic
resonance angiography (MRA) and duplex ultrasonography with arteriography
for the detection of 70% to 99% stenoses at the carotid artery bifurcation
(ie, surgical disease according to findings of the North American Carotid
Endarterectomy Trial). METHODS--Three blinded readers independently
measured stenoses on MRA in 73 vessels from 38 patients. Duplex
ultrasonography was available in 66 vessels from 35 of these patients, and
blinded reading was performed by one reader. Comparison was made to
arteriography. RESULTS--Magnetic resonance angiography demonstrated a
sensitivity of 92.4%, specificity of 74.5%, and negative predictive value
of 95.8% for 70% to 99% stenoses. Interobserver agreement was high (kappa =
0.91). Absence of signal at stenoses with evidence of distal flow usually,
but not always, corresponded to surgical disease. Duplex ultrasonography
demonstrated a sensitivity of 81.0%, specificity of 82.2%, and negative
predictive value of 90.2% for surgical disease. There was no significant
difference between MRA and duplex ultrasonography for the sensitivity or
specificity in detecting 70% to 99% stenoses (P > .1, exact form of the
McNemar test). MRA had no false positives or false negatives for complete
occlusions of the carotid artery, whereas duplex ultrasonography missed one
occlusion and falsely called two patent vessels occluded. In seven cases,
both MRA and duplex ultrasonography overestimated stenoses to miscategorize
them as surgical disease. CONCLUSIONS--Although the sensitivity and
specificity of MRA and duplex ultrasonography are not significantly
different for distinguishing surgical and nonsurgical degrees of stenosis
at the carotid bifurcation, MRA has some advantages that may make it the
screening test of choice. Concordant MRA and duplex ultrasonography for
surgical disease does not necessarily obviate the need for catheter
arteriography.
ARTICLES
Blinded-reader comparison of magnetic resonance angiography and duplex ultrasonography for carotid artery bifurcation stenosis
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104.
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