Published Online
on November 29, 2004

A more recent version of this article appeared on January 1, 2005

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Submitted on June 29, 2004
Accepted on October 1, 2004

Noninvasive Detection of Steno-Occlusive Disease of the Supra-Aortic Arteries With Three-Dimensional Contrast-Enhanced Magnetic Resonance Angiography. A Prospective, Intra-Individual Comparative Analysis With Digital Subtraction Angiography

Winfried A. Willinek MD^*; Marcus von Falkenhausen MD; Markus Born MD; Jürgen Gieseke PhD, MD; Tobias Höller MSc; Thomas Klockgether MD; Hans J. Textor MD; Hans H. Schild MD; and Horst Urbach MD

From the Department of Radiology (W.A.W., M.v.F., M.B., J.G., H.J.T., H.H.S., H.U.), Institute of Medical Biometrics, Informatics, and Epidemiology (T.H.), and the Department of Neurology (T.K.), University of Bonn, Germany.

^* To whom correspondence should be addressed. E-mail: winfried.willinek{at}ukb.uni-bonn.de.

Background and Purpose--Concomitant disease of the supra-aortic arteries can influence the outcome of surgical treatment of carotid artery stenosis. However, sensitivity and specificity data of noninvasive contrast-enhanced 3-dimensional (3D) magnetic resonance angiography (CE MRA) for the detection of steno-occlusive disease of the entire supra-aortic arteries including the circle of Willis remain unclear. We aimed to intra-individually compare high-spatial-resolution CE 3D MRA and digital subtraction angiography (DSA) for the assessment of steno-occlusive vascular disease of the supra-aortic arteries.

Methods--CE MRA and DSA of the supra-aortic arteries were prospectively performed in 50 consecutive patients. Intra-individual comparison of CE MRA and DSA was available in 833 arteries. High-spatial-resolution CE MRA comprised a measured voxel size of 0.81 mm x 0.81 mm x 1 mm (0.66 mm³). Steno-occlusive vascular disease of the 833 arteries was assessed independently by 2 radiologists according to the NASCET criteria.

Results--CE MRA had a sensitivity of 100% (73/73), a specificity of 99.3% (760/765), a positive predictive value of 93.6% (73/78), and a negative predictive value of 100% (760/760) by using a 70% to 99% threshold of arterial diameter stenosis. For detection of occlusion, sensitivity, specificity, PPV, and NPV value of CE MRA were 100%, respectively.

Conclusions--Noninvasive high-spatial-resolution CE MRA is suited to replace diagnostic DSA for the detection of steno-occlusive disease of the supra-aortic arteries.

Key words: carotid stenosis • comparative study • magnetic resonance angiography • magnetic resonance imaging • supra-aortic arteries

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