on September 2, 2004
Published online before print September 2, 2004, doi: 10.1161/01.STR.0000141426.63959.cc
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on March 26, 2004
From the Departments of Surgery (M.J.W.K.), Neurology (P.J.N.), Clinical Epidemiology & Biostatics (J.B.R.), and Radiology (C.B.M.), Academic Medical Center, Amsterdam, The Netherlands. * To whom correspondence should be addressed. E-mail: p.j.nederkoorn{at}amc.uva.nl.
Background and Purpose--To review the literature on the diagnostic accuracy of computed tomographic angiography (CTA) compared with arteriography/intra-arterial digital subtraction angiography as reference standard for assessment of symptomatic carotid artery disease. Methods--The PubMed, MEDLINE, PREMEDLINE, EMBASE, and CINAHL databases were searched to retrieve studies published between 1990 and July 2003, comparing CTA and intra-arterial digital subtraction angiography in patients with symptomatic carotid artery disease that presented raw data for detection of a <70% or 70% to 99% stenosis or an occlusion. Two observers independently assessed methodological quality and constructed 2x2 tables for sensitivity and specificity of CTA for detection of a 70% to 99% stenosis versus <70% stenosis or an occlusion, and for <99% stenosis versus occlusion. A bivariate random effects model was used to calculate the pooled sensitivity and specificity of CTA for detection of these lesions. Results--Some 864 patients (66% male) with a mean age of 66 years were studied in the 28 studies included in the meta-analysis. In all studies, a single-slice CT-scan was used. Only 8 studies satisfied all methodological quality criteria. The pooled sensitivity and specificity for detection of a 70% to 99% stenosis were 85% (95% CI, 79% to 89%) and 93% (95% CI, 89% to 96%), respectively. For detection of an occlusion, the sensitivity and specificity were 97% (95% CI, 93% to 99%) and 99% (95% CI, 98% to 100%), respectively. Incomplete reporting of demographic characteristics and technical differences in the individual studies obstructed a meaningful subgroup analysis. Conclusions--CTA is an accurate modality for detection of severe carotid artery disease, especially for detection of occlusions. The fair methodological quality of the included studies must be taken into account when interpreting these results.
Revised on June 23, 2004
Accepted on July 5, 2004
Systematic Review of Computed Tomographic Angiography for Assessment of Carotid Artery Disease
Mark J.W. Koelemay MD, PhD;
Key words: angiography • carotid stenosis • computed tomography • diagnosis • meta-analysis • review, systematic
This article has been cited by other articles:
 |
|
 |
|
  A. J. Fox, S. P. Symons, R. I. Aviv, P. Howard, R. Yeung, and E. S. Bartlett Should Modeling Methodology Suppress Anatomic Excellence? Stroke, November 1, 2009; 40(11): 3411 - 3412. [Full Text] [PDF]
|
|
|
|
 |
|
 F. M. Chappell, J. M. Wardlaw, G. R. Young, J. H. Gillard, G. H. Roditi, B. Yip, J. P. Pell, P. M. Rothwell, M. M. Brown, M. J. Gough, et al. Carotid Artery Stenosis: Accuracy of Noninvasive Tests--Individual Patient Data Meta-Analysis Radiology, May 1, 2009; 251(2): 493 - 502. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L.S. Babiarz, J.M. Romero, E.K. Murphy, B. Brobeck, P.W. Schaefer, R.G. Gonzalez, and M.H. Lev Contrast-Enhanced MR Angiography Is Not More Accurate Than Unenhanced 2D Time-of-Flight MR Angiography for Determining >=70% Internal Carotid Artery Stenosis AJNR Am. J. Neuroradiol., April 1, 2009; 30(4): 761 - 768. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. R Jaff, G. V Goldmakher, M. H Lev, and J. M Romero Imaging of the carotid arteries: the role of duplex ultrasonography, magnetic resonance arteriography, and computerized tomographic arteriography Vascular Medicine, November 1, 2008; 13(4): 281 - 292. [Abstract] [PDF]
|
|
|
|
 |
|
 T. Wolff, J. Guirguis-Blake, T. Miller, M. Gillespie, and R. Harris Screening for Carotid Artery Stenosis: An Update of the Evidence for the U.S. Preventive Services Task Force Ann Intern Med, December 18, 2007; 147(12): 860 - 870. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M. Kramer, M. J. Budoff, Z. A. Fayad, V. A. Ferrari, C. Goldman, J. R. Lesser, E. T. Martin, S. Rajagopalan, J. P. Reilly, G. P. Rodgers, et al. ACCF/AHA 2007 Clinical Competence Statement on vascular imaging with computed tomography and magnetic resonance Vascular Medicine, November 1, 2007; 12(4): 359 - 378. [PDF]
|
|
|
|
 |
|
 C. M. Kramer, M. J. Budoff, Z. A. Fayad, V. A. Ferrari, C. Goldman, J. R. Lesser, E. T. Martin, S. Rajagopalan, J. P. Reilly, G. P. Rodgers, et al. ACCF/AHA 2007 Clinical Competence Statement on Vascular Imaging With Computed Tomography and Magnetic Resonance: A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training Developed in Collaboration With the Society of Atherosclerosis Imaging and Prevention, the Society for Cardiovascular Angiography and Interventions, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society for Vascular Medicine and Biology J. Am. Coll. Cardiol., September 11, 2007; 50(11): 1097 - 1114. [Full Text] [PDF]
|
|
|
|
|
|
R. L. DeLaPaz and for the Expert Panel on Neurologic Imaging Cerebrovascular Disease AJNR Am. J. Neuroradiol., June 1, 2007; 28(6): 1197 - 1199. [Full Text] [PDF]
|
|
|
|
|
|
E. S. Bartlett, T. D. Walters, S. P. Symons, and A. J. Fox Carotid Stenosis Index Revisited With Direct CT Angiography Measurement of Carotid Arteries to Quantify Carotid Stenosis Stroke, February 1, 2007; 38(2): 286 - 291. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
American Society of Interventional & Therapeutic N, Society for Cardiovascular Angiography and Interve, Society for Vascular Medicine and Biology, Society of Interventional Radiology, E. R. Bates, J. D. Babb, D. E. Casey Jr, C. U. Cates, G. R. Duckwiler, T. E. Feldman, et al. ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (ACCF/SCAI/SVMB/SIR/ASITN Clinical Expert Consensus Document Committee on Carotid Stenting) J. Am. Coll. Cardiol., January 2, 2007; 49(1): 126 - 170. [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 T. T. de Weert, M. Ouhlous, E. Meijering, P. E. Zondervan, J. M. Hendriks, M. R.H.M. van Sambeek, D. W.J. Dippel, and A. van der Lugt In Vivo Characterization and Quantification of Atherosclerotic Carotid Plaque Components With Multidetector Computed Tomography and Histopathological Correlation Arterioscler Thromb Vasc Biol, October 1, 2006; 26(10): 2366 - 2372. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E.S. Bartlett, T.D. Walters, S.P. Symons, and A.J. Fox Diagnosing Carotid Stenosis Near-Occlusion by Using CT Angiography AJNR Am. J. Neuroradiol., March 1, 2006; 27(3): 632 - 637. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E.S. Bartlett, S.P. Symons, and A.J. Fox Correlation of Carotid Stenosis Diameter and Cross-Sectional Areas with CT Angiography AJNR Am. J. Neuroradiol., March 1, 2006; 27(3): 638 - 642. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E.S. Bartlett, T.D. Walters, S.P. Symons, and A.J. Fox Quantification of Carotid Stenosis on CT Angiography AJNR Am. J. Neuroradiol., January 1, 2006; 27(1): 13 - 19. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Mutze, G. Rademacher, G. Matthes, N. Hosten, and D. Stengel Blunt Cerebrovascular Injury in Patients with Blunt Multiple Trauma: Diagnostic Accuracy of Duplex Doppler US and Early CT Angiography Radiology, December 1, 2005; 237(3): 884 - 892. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. D. Bui, D. Gelfand, S. Whipple, S. E. Wilson, R. M. Fujitani, R. Conroy, H. Pham, and I. L. Gordon Comparison of CT and Catheter Arteriography for Evaluation of Peripheral Arterial Disease Vascular and Endovascular Surgery, November 1, 2005; 39(6): 481 - 490. [Abstract] [PDF]
|
|
|
|
 |
|
 H. Ota, K. Takase, H. Rikimaru, M. Tsuboi, T. Yamada, A. Sato, S. Higano, T. Ishibashi, and S. Takahashi Quantitative Vascular Measurements in Arterial Occlusive Disease RadioGraphics, September 1, 2005; 25(5): 1141 - 1158. [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]
|
|