on February 20, 2003
Published online before print February 20, 2003, doi: 10.1161/01.STR.0000057462.02141.6F
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Submitted on August 26, 2002
From the Departments of Neuroscience (M.C., G.L., R.C., G.P.) and Radiology (M.C.M., C.B.), University of Pisa; Service of Neuroradiology, AO (M.P., A.A.); and Clinical Physiology, Institute CNR (A.P., M.L.), Pisa, Italy. * To whom correspondence should be addressed. E-mail: mircocosottini{at}hotmail.com.
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 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.
Accepted on September 24, 2002
Contrast-Enhanced Three-Dimensional Magnetic Resonance Angiography of Atherosclerotic Internal Carotid Stenosis as the Noninvasive Imaging Modality in Revascularization Decision Making
Mirco Cosottini MD*;
=0.87. The misclassification rate of CEMRA was 3.1% because of its tendency to overestimate the stenosis.
Key words: carotid arteries • carotid endarterectomy • comparative study • magnetic resonance angiography
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