Published Online
on July 8, 2004

A more recent version of this article appeared on September 1, 2004

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Submitted on January 16, 2004
Revised on April 21, 2004
Accepted on June 1, 2004

Measuring Carotid Stenosis on Contrast-Enhanced Magnetic Resonance Angiography. Diagnostic Performance and Reproducibility of 3 Different Methods

Jean Marie K.S. U-King-Im MRCS; Rikin A. Trivedi MRCP, MRCS; Justin J. Cross MRCP, FRCR; Nicholas J.P. Higgins MRCP, FRCR; William Hollingworth PhD; Martin Graves MSc; Ilse Joubert; Peter J. Kirkpatrick MSc, FRCS; Nagui M. Antoun FRCP, FRCR; and Jonathan H. Gillard BSc, MD, FRCR^*

From the University Department of Radiology, Addenbrooke’s Hospital, Cambridge, United Kingdom.

^* To whom correspondence should be addressed. E-mail: jhg21{at}cam.ac.uk.

Background and Purpose--The aim of this study was to compare diagnostic performance and reproducibility of 3 different methods of quantifying stenosis on contrast-enhanced magnetic resonance angiography (CEMRA), with intra-arterial digital subtraction angiography (DSA) as the reference standard.

Methods--167 symptomatic patients scheduled for DSA, after screening Doppler ultrasound, were prospectively recruited to undergo CEMRA. Severity of stenosis was measured according to the North American Symptomatic Trial Collaborators (NASCET), European Carotid Surgery Trial (ECST), and the common carotid (CC) methods. Measurements for each method were made for 284 vessels (142 included patients) on both CEMRA and DSA in a blinded and randomized manner by 3 independent attending neuroradiologists.

Results--Significant differences in prevalence of severe stenosis were seen with the 3 methods on both DSA and CEMRA, with ECST yielding the least and NASCET the most cases of severe stenosis. Overall, all 3 methods performed similarly well in terms of intermodality correlation and agreement. No significant differences in interobserver agreement were found on either modality. With CEMRA, however, we found a significantly lower sensitivity for detection of severe stenosis with ECST (79.8%) compared with NASCET (93.0%), with DSA as reference standard.

Conclusions--Uniformity of carotid stenosis measurement methods is desirable because patient management may otherwise differ substantially. All 3 methods are adequate for use with DSA. With CEMRA, however, this study supports use of the NASCET method because of improved sensitivity for detecting severe stenosis.

Key words: carotid stenosis • angiography • magnetic resonance imaging

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