(Stroke. 1999;30:1444-1449.)
© 1999 American Heart Association, Inc.
Original Contributions |
Reliability and Validity of Noninvasive Imaging of Internal Carotid Artery Pseudo-Occlusion
From the Institute of Diagnostic Radiology (G.F., A.S., F.W., J.M., M.C., A.A.) and Department of Neurology (T.N.-H., M. Schroeder), Heinrich-Heine-University Düsseldorf, and the Department of Neurology (H.S., M. Sitzer), J.W. Goethe University, Frankfurt am Main, Germany.
Correspondence to Dr Günter Fürst, MD, Institute of Diagnostic Radiology, Heinrich-Heine-University Düsseldorf, Moorenstr 5, D-40225 Düsseldorf, Germany. E-mail f\|[uuml ]\|rstg{at}uni-duesseldorf.de
Background and Purpose—Our study evaluated noninvasive tests for the diagnosis of atheromatous internal carotid artery (ICA) pseudo-occlusion.
Methods—Twenty patients (17 men, 3 women; mean age ±SD,
64.3±11.6 years) with angiographically proven
atheromatous ICA pseudo-occlusion (20 vessels) were
prospectively examined with MR angiography (MRA; 2D and 3D
time-of-flight techniques), color Doppler–assisted duplex imaging
(CDDI) and power-flow imaging (PFI) with and without an
intravenous ultrasonic contrast agent. As a control group,
13 patients (13 men; mean±SD age, 63.0±9.0 years) with
angiographically proven ICA occlusion (13 vessels) were studied with
the same techniques. For the determination of interobserver agreement
(
statistics), the findings of each diagnostic technique
were read by 2 blinded and independent observers who were not involved
in patient recruitment and initial data acquisition. Specificity and
sensitivity were calculated for all noninvasive techniques (observer
consensus) in comparison to the standard of reference
(intra-arterial angiography).
Results—Interobserver reliabilities were =0.86 for
intra-arterial angiography, =0.90 for unenhanced CDDI,
=0.93 for enhanced CDDI, =0.93 for unenhanced PFI, =1.0 for
enhanced PFI, =0.93 for 2D MRA, and =0.77 for 3D MRA,
respectively (P<0.0001). Specificities and
sensitivities were 0.92 and 0.70 for unenhanced CDDI, 0.92 and 0.83 for
enhanced CDDI, 0.92 and 0.95 for unenhanced PFI, 1.0 and 0.94 for
enhanced PFI, 1.0 and 0.65 for 2D MRA, and 0.89 and 0.47 for 3D MRA,
respectively.
Conclusions—Advanced ultrasonographic techniques, especially PFI (with only 1 false-positive diagnosis of occlusion in the present series), can provide reliable and valid data to differentiate between ICA pseudo-occlusion and complete occlusion. In contrast, time-of-flight MRA at its present state is not capable of predicting minimal residual flow within a nearly occluded ICA.
Key Words: angiography, digital subtraction • angiography, magnetic resonance • carotid artery diseases • carotid artery occlusion • contrast media • ultrasonography
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