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(Stroke. 2009;40:e1.)
© 2009 American Heart Association, Inc.

Letters to the Editor

Accuracy of Magnetic Resonance Angiography for Internal Carotid Artery Disease

Instituto de Neurologia Deolindo Couto/Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

Charles André

Hospital Universitário Clementino Fraga Filho/Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

We read with great interest the article entitled "Diagnostic accuracy of magnetic resonance angiography for internal carotid artery disease: a systematic review and meta-analysis."¹ The authors made a comprehensive review and meta-analysis of many articles which compared magnetic resonance angiography (MRA) and digital angiography (DGA), considered the gold standard to study carotid stenosis.

As a contribution, although not cited by the authors, we published an article in 2001² about this theme. We compared, in a prospective longitudinal study, 20 internal carotid arteries (ICA) in 10 patients with symptomatic stenosis submitted to screening carotid Doppler studies. Six patients had transient ischemic attacks and 4 had mild strokes. Subjects with 70% or tighter stenosis in this first evaluation were submitted to another carotid duplex scan, bidimensional time-of-flight MRA and DGA, in order to compare these diagnostic methods. We used the NASCET³ method to measure ICA stenosis, and we considered DGA as the gold standard. Each diagnostic procedure was independently evaluated by the participating physicians, who were blind to the results of other tests.

We found an excellent correlation between the methods when we divided our sample in surgical (70% to 99% stenosis) and nonsurgical patients. Sensitivity (95% CI) for detecting ‘surgical patients’ (70% to 99% stenosis) was 100% (39.6% to 100%) for both duplex scan and bidimensional time-of-flight MRA, compared to DGA, and specificity was 93.8% (67.7% to 99.7%) and 75% (47.4% to 91.7%) respectively. Positive predictive value (95% CI) was 80% (29.9% to 98.9%) for duplex scan and . . . [Full Text of this Article]