doi: 10.1161/01.STR.0000021900.58396.44
(Stroke. 2002;33:2003.)
© 2002 American Heart Association, Inc.
Original Contributions |
Preoperative Diagnosis of Carotid Artery Stenosis
Accuracy of Noninvasive Testing
From the Julius Center for Patient Oriented Research (P.J.N., E.B., Y. van der G.) and Departments of Radiology (W.P.M., O.E.H.E., P.C.B., A.F.W.), Vascular Surgery (B.C.E.), and Neurology (L.J.K.), University Medical Center Utrecht, Utrecht, Netherlands; Departments of Radiology (M.G.H., A. van der L.) and Epidemiology and Biostatistics (M.G.H.), Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; and Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass (M.G.H.).
Correspondence to Dr Y. van der Graaf, Julius Center for Patient Oriented Research, D.01.335, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, Netherlands. E-mail Y.vanderGraaf{at}jc.azu.nl
Background and Purpose— Carotid endarterectomy has been shown to be beneficial in symptomatic patients with a severe stenosis (70% to 99%) of the internal carotid artery (ICA). Digital subtraction angiography (DSA) is the standard of reference in the diagnosis of carotid artery stenosis but has a relatively high complication rate. In a diagnostic study we investigated the accuracy of noninvasive testing compared with DSA.
Methods— In a prospective diagnostic study we performed duplex ultrasound (DUS), magnetic resonance angiography (MRA), and DSA on 350 consecutive symptomatic patients. Stenoses were measured with the observers blinded for clinical information and other test results. Separate and combined test results of DUS and MRA were compared with the reference standard DSA. Only the stenosis measurements of the arteries on the symptomatic side were included in the analyses.
Results— DUS analyzed with previously defined criteria resulted in a sensitivity of 87.5% (95% CI, 82.1% to 92.9%) and a specificity of 75.7% (95% CI, 69.3% to 82.2%) in identifying severe ICA stenosis (70% to 99%). Stenosis measurements on MRA yielded a sensitivity of 92.2% (95% CI, 86.2% to 96.2%) and a specificity of 75.7% (95% CI, 68.6% to 82.5%). When we combined MRA and DUS results, agreement between these 2 modalities (84% of patients) gave a sensitivity of 96.3% (95% CI, 90.8% to 99.0%) and a specificity of 80.2% (95% CI, 73.1% to 87.3%) for identifying severe stenosis.
Conclusions— MRA showed a slightly better accuracy than DUS in the diagnosis of carotid artery stenosis. To achieve the best accuracy, however, both tests should be performed subsequently.
Key Words: angiography, digital subtraction • carotid endarterectomy • carotid stenosis • magnetic resonance angiography • ultrasonography, Doppler, duplex
This article has been cited by other articles:
 |
|
 |
|
  M. Lell, C. Fellner, U. Baum, T. Hothorn, R. Steiner, W. Lang, W. Bautz, and F.A. Fellner Evaluation of Carotid Artery Stenosis with Multisection CT and MR Imaging: Influence of Imaging Modality and Postprocessing AJNR Am. J. Neuroradiol., January 1, 2007; 28(1): 104 - 110. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A.S. Turk, K.M. Johnson, D. Lum, D. Niemann, B. Aagaard-Kienitz, D. Consigny, J. Grinde, P. Turski, V. Haughton, and C. Mistretta Physiologic and Anatomic Assessment of a Canine Carotid Artery Stenosis Model Utilizing Phase Contrast with Vastly Undersampled Isotropic Projection Imaging AJNR Am. J. Neuroradiol., January 1, 2007; 28(1): 111 - 115. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. H. Heijenbrok-Kal, E. Buskens, P. J. Nederkoorn, Y. van der Graaf, and M. G. M. Hunink Optimal Peak Systolic Velocity Threshold at Duplex US for Determining the Need for Carotid Endarterectomy: A Decision Analytic Approach Radiology, December 21, 2005; (2005) 2381041078. [Abstract] [Full Text]
|
|
|
|
|
|
C. de Monye, F. Cademartiri, T. T. de Weert, D. A. M. Siepman, D. W. J. Dippel, and A. van Der Lugt Sixteen-Detector Row CT Angiography of Carotid Arteries: Comparison of Different Volumes of Contrast Material with and without a Bolus Chaser Radiology, November 1, 2005; 237(2): 555 - 562. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. H. Heijenbrok-Kal, P. J. Nederkoorn, E. Buskens, Y. van der Graaf, and M.G. Myriam Hunink Diagnostic Performance of Duplex Ultrasound in Patients Suspected of Carotid Artery Disease: The Ipsilateral Versus Contralateral Artery Stroke, October 1, 2005; 36(10): 2105 - 2109. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Gaitini and M. Soudack Diagnosing Carotid Stenosis by Doppler Sonography: State of the Art J. Ultrasound Med., August 1, 2005; 24(8): 1127 - 1136. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Anzalone, F. Scomazzoni, R. Castellano, L. Strada, C. Righi, L. S. Politi, M. A. Kirchin, R. Chiesa, and G. Scotti Carotid Artery Stenosis: Intraindividual Correlations of 3D Time-of-Flight MR Angiography, Contrast-enhanced MR Angiography, Conventional DSA, and Rotational Angiography for Detection and Grading Radiology, July 1, 2005; 236(1): 204 - 213. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. P. Derdeyn, E. Buskens, P. J. Nederkoorn, Y. van der Graaf, and M. G. M. Hunink Conventional Angiography Remains an Important Tool for Measurement of Carotid Arterial Stenosis * Dr Buskens and colleagues respond: Radiology, May 1, 2005; 235(2): 711 - 713. [Full Text] [PDF]
|
|
|
|
 |
|
 S. C. Goehde, P. Hunold, F. M. Vogt, W. Ajaj, M. Goyen, C. U. Herborn, M. Forsting, J. F. Debatin, and S. G. Ruehm Full-Body Cardiovascular and Tumor MRI for Early Detection of Disease: Feasibility and Initial Experience in 298 Subjects Am. J. Roentgenol., February 1, 2005; 184(2): 598 - 611. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. E. Hyde, A. J. Fox, I. Gulka, P. Kalapos, D. H. Lee, D. M. Pelz, and D. W. Holdsworth Internal Carotid Artery Stenosis Measurement: Comparison of 3D Computed Rotational Angiography and Conventional Digital Subtraction Angiography Stroke, December 1, 2004; 35(12): 2776 - 2781. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Buskens, P. J. Nederkoorn, T. Buijs-van der Woude, W. P. T. M. Mali, L. J. Kappelle, B. C. Eikelboom, Y. van der Graaf, and M. G. Myriam Hunink Imaging of Carotid Arteries in Symptomatic Patients: Cost-effectiveness of Diagnostic Strategies Radiology, October 1, 2004; 233(1): 101 - 112. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J.W. Koelemay, P. J. Nederkoorn, J. B. Reitsma, and C. B. Majoie Systematic Review of Computed Tomographic Angiography for Assessment of Carotid Artery Disease Stroke, October 1, 2004; 35(10): 2306 - 2312. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. K. DeMarco, J. Huston III, and M. A. Bernstein Evaluation of Classic 2D Time-of-Flight MR Angiography in the Depiction of Severe Carotid Stenosis Am. J. Roentgenol., September 1, 2004; 183(3): 787 - 793. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Sabeti, M. Schillinger, W. Mlekusch, A. Willfort, M. Haumer, T. Nachtmann, M. Mullner, W. Lang, R. Ahmadi, and E. Minar Quantification of Internal Carotid Artery Stenosis with Duplex US: Comparative Analysis of Different Flow Velocity Criteria Radiology, August 1, 2004; 232(2): 431 - 439. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. H. Wierks and N. Labropoulos Noninvasive Carotid Imaging Perspectives in Vascular Surgery and Endovascular Therapy, June 1, 2004; 16(2): 89 - 99. [Abstract] [PDF]
|
|
|
|
|
|
G. Rigatelli, P. J. Nederkoorn, W. P.T.M. Mali, L. J. Kappelle, and Y. van der Graaf Diagnosis of Carotid Artery Occlusive Disease in Patients Scheduled for Cardiac or Vascular Surgery: Is This a Place for Invasive Selective Carotid Angiography? * Response: Combined Testing of Cardiac and Carotid Artery Stenosis? Stroke, May 1, 2004; 35(5): e89 - e90. [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. U-King-Im, R. A. Trivedi, M. J. Graves, N. J. Higgins, J. J. Cross, B. D. Tom, W. Hollingworth, H. Eales, E. A. Warburton, P. J. Kirkpatrick, et al. Contrast-enhanced MR angiography for carotid disease: Diagnostic and potential clinical impact Neurology, April 27, 2004; 62(8): 1282 - 1290. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Nonent, J.-M. Serfaty, N. Nighoghossian, F. Rouhart, L. Derex, C. Rotaru, P. Chirossel, B. Guias, J.-F. Heautot, P. Gouny, et al. Concordance Rate Differences of 3 Noninvasive Imaging Techniques to Measure Carotid Stenosis in Clinical Routine Practice: Results of the CARMEDAS Multicenter Study Stroke, March 1, 2004; 35(3): 682 - 686. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Nederkoorn, O. E. H. Elgersma, Y. van der Graaf, B. C. Eikelboom, L. J. Kappelle, and W. P. T. M. Mali Carotid Artery Stenosis: Accuracy of Contrast-enhanced MR Angiography for Diagnosis Radiology, September 1, 2003; 228(3): 677 - 682. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 ADDITIONAL ARTICLES ABSTRACTED IN ACP JOURNAL CLUB Evid. Based Med., March 1, 2003; 8(2): 35 - 35. [Full Text] [PDF]
|
|
|
|
 |
|
 Preoperative Diagnosis of Carotid Stenosis by Noninvasive Testing Journal Watch Neurology, November 21, 2002; 2002(1121): 2 - 2. [Full Text]
|
|
|
|
|
|
P. J. Nederkoorn, Y. van der Graaf, B. C. Eikelboom, A. van der Lugt, L. W. Bartels, and W. P.T.M. Mali Time-of-Flight MR Angiography of Carotid Artery Stenosis: Does a Flow Void Represent Severe Stenosis? AJNR Am. J. Neuroradiol., November 1, 2002; 23(10): 1779 - 1784. [Abstract] [Full Text] [PDF]
|
|