Carotid artery stenosis: intraindividual correlations of 3D time-of-flight MR angiography, contrast-enhanced MR angiography, conventional DSA, and rotational angiography for detection and grading.

PURPOSE To compare three-dimensional (3D) time-of-flight (TOF) MR angiography, contrast-enhanced MR angiography, digital subtraction angiography (DSA), and rotational angiography for depiction of stenosis. MATERIALS AND METHODS The study had Ethics Committee approval, and each patient gave written informed consent. Forty-nine patients (18 women, mean age, 67.2 years +/- 9.1 [+/- standard deviation], and 31 men, mean age, 63.1 years +/- 8.0) with symptomatic stenosis of internal carotid artery (ICA) diagnosed at duplex ultrasonography underwent transverse 3D TOF MR angiography with sliding interleaved kY acquisition and coronal contrast-enhanced MR angiography, followed by DSA and rotational angiography within 48 hours. MR angiography was performed at 1.5-T with a cervical coil. Contrast-enhanced MR angiograms were obtained after a bolus injection of 20 mL of gadobenate dimeglumine. Maximum ICA stenosis on maximum intensity projection and source images was quantified according to NASCET criteria. Correlations for 3D TOF MR angiography, contrast-enhanced MR angiography, DSA, and rotational angiography were determined by means of cross tabulation, and accuracy for detection and grading of stenoses were calculated. Data were evaluated with analysis of variance, Wilcoxon signed rank test, and McNemar test, all at significance of P < .05. RESULTS Ninety-eight ICAs were evaluated at contrast-enhanced MR angiography, DSA, and rotational angiography, and 97 were evaluated at 3D TOF MR angiography. Correlations for contrast-enhanced MR angiography, 3D TOF MR angiography, and DSA relative to rotational angiography were r2 = 0.9332, r2 = 0.9048, and r2 = 0.9255, respectively. Lower correlation (r2 = 0.8593) was noted for contrast-enhanced MR angiography and DSA. Respective sensitivity and specificity for detection of hemodynamically relevant stenosis relative to rotational angiography were 100% and 90% for contrast-enhanced MR angiography, 95.5% and 87.2% for 3D TOF MR angiography, and 88.6% and 100% for DSA. Four of 31 severe stenoses were underestimated at DSA, and three were underestimated at contrast-enhanced MR angiography. Three severe stenoses were underestimated at 3D TOF MR angiography, and one was misclassified as occluded. Of 13 moderate (50%-69%) stenoses, one was overestimated at contrast-enhanced MR angiography, two were underestimated and three overestimated at 3D TOF MR angiography, and two were underestimated at DSA. CONCLUSION DSA results in an underestimation of ICA stenosis compared with rotational angiography. Contrast-enhanced MR angiography correlates best with rotational angiography.

[1]  Suzie M El-Saden,et al.  Accuracy of contrast-enhanced MR angiography in predicting angiographic stenosis of the internal carotid artery: linear regression analysis. , 2003, AJNR. American journal of neuroradiology.

[2]  P. Nederkoorn,et al.  Carotid artery stenosis: accuracy of contrast-enhanced MR angiography for diagnosis. , 2003, Radiology.

[3]  G. Marchal,et al.  Gadobenate Dimeglumine‐Enhanced Magnetic Resonance Angiography of the Pelvic Arteries , 2003, Investigative radiology.

[4]  D. Saloner,et al.  Contrast material-enhanced MRA overestimates severity of carotid stenosis, compared with 3D time-of-flight MRA. , 2003, Journal of vascular surgery.

[5]  Martin Requardt,et al.  Contrast‐enhanced MR angiography of the run‐off vasculature: Intraindividual comparison of gadobenate dimeglumine with gadopentetate dimeglumine , 2003, Journal of magnetic resonance imaging : JMRI.

[6]  Markus Horn,et al.  Preoperative evaluation of carotid artery stenosis: comparison of contrast-enhanced MR angiography and duplex sonography with digital subtraction angiography. , 2003, AJNR. American journal of neuroradiology.

[7]  Juan Alvarez-Linera,et al.  Prospective evaluation of carotid artery stenosis: elliptic centric contrast-enhanced MR angiography and spiral CT angiography compared with digital subtraction angiography. , 2003, AJNR. American journal of neuroradiology.

[8]  Paul J. Nederkoorn,et al.  Duplex Ultrasound and Magnetic Resonance Angiography Compared With Digital Subtraction Angiography in Carotid Artery Stenosis: A Systematic Review , 2003, Stroke.

[9]  L. Cozzi,et al.  Prospective blinded evaluation of Gd-DOTA- versus Gd-BOPTA-enhanced peripheral MR angiography, as compared with digital subtraction angiography. , 2003, Radiology.

[10]  C. Bartolozzi,et al.  Contrast-Enhanced Three-Dimensional Magnetic Resonance Angiography of Atherosclerotic Internal Carotid Stenosis as the Noninvasive Imaging Modality in Revascularization Decision Making , 2003, Stroke.

[11]  S. A. Gutnikov,et al.  Reanalysis of the Final Results of the European Carotid Surgery Trial , 2003, Stroke.

[12]  S. Gutnikov,et al.  Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis , 2003, The Lancet.

[13]  C. Bartolozzi,et al.  Contrast-enhanced three-dimensional MR angiography of neck vessels: does dephasing effect alter diagnostic accuracy? , 2003, European Radiology.

[14]  G. Marchal,et al.  Gadobenate dimeglumine-enhanced MR angiography of the abdominal aorta and renal arteries. , 2002, AJR. American journal of roentgenology.

[15]  M. Bock,et al.  Assessment of Gadobenate Dimeglumine for Magnetic Resonance Angiography: Phase I Studies , 2002, Investigative radiology.

[16]  J. Eastwood,et al.  Contrast-Enhanced Magnetic Resonance Angiography of Carotid Arteries: Utility in Routine Clinical Practice , 2002, Stroke.

[17]  W. Nitz,et al.  Time-Resolved Contrast-Enhanced Magnetic Resonance Angiography of the Carotid Arteries: Diagnostic Accuracy and Inter-Observer Variability Compared With Selective Catheter Angiography , 2002, Investigative radiology.

[18]  Eun-Kee Jeong,et al.  Reduction of flow‐related signal loss in flow‐compensated 3D TOF MR angiography, using variable echo time (3D TOF‐VTE) , 2002, Magnetic resonance in medicine.

[19]  Erik Buskens,et al.  Preoperative Diagnosis of Carotid Artery Stenosis: Accuracy of Noninvasive Testing , 2002, Stroke.

[20]  E. Larsson,et al.  Carotid artery stenosis: contrast-enhanced MR angiography with two different scan times compared with digital subtraction angiography , 2002, Neuroradiology.

[21]  Franz A Fellner,et al.  High-Resolution, Contrast-Enhanced Magnetic Resonance Angiography With Elliptical Centric k-Space Ordering of Supra-aortic Arteries Compared With Selective X-Ray Angiography , 2002, Stroke.

[22]  G. Schroth,et al.  Contrast-enhanced 3D MR angiography of the carotid artery: comparison with conventional digital subtraction angiography. , 2002, AJNR. American journal of neuroradiology.

[23]  L. Goldstein,et al.  Low rate of complications of cerebral angiography in routine clinical practice , 2001, Neurology.

[24]  M. Völk,et al.  Renal time-resolved MR angiography: quantitative comparison of gadobenate dimeglumine and gadopentetate dimeglumine with different doses. , 2001, Radiology.

[25]  S J Riederer,et al.  Carotid artery: elliptic centric contrast-enhanced MR angiography compared with conventional angiography. , 2001, Radiology.

[26]  I. Wilkinson,et al.  Comparison of Doppler ultrasound, magnetic resonance angiographic techniques and catheter angiography in evaluation of carotid stenosis. , 2000, Clinical radiology.

[27]  W. Mali,et al.  Multidirectional depiction of internal carotid arterial stenosis: three-dimensional time-of-flight MR angiography versus rotational and conventional digital subtraction angiography. , 2000, Radiology.

[28]  J C Froment,et al.  Accuracy of three-dimensional gadolinium-enhanced MR angiography in the assessment of extracranial carotid artery disease. , 2000, AJR. American journal of roentgenology.

[29]  W. Bautz,et al.  Fluoroscopically triggered contrast-enhanced 3D MR DSA and 3D time-of-flight turbo MRA of the carotid arteries: first clinical experiences in correlation with ultrasound, x-ray angiography, and endarterectomy findings. , 2000, Magnetic resonance imaging.

[30]  W. Mali,et al.  Maximum internal carotid arterial stenosis: assessment with rotational angiography versus conventional intraarterial digital subtraction angiography. , 1999, Radiology.

[31]  M. Koltzenburg,et al.  Silent embolism in diagnostic cerebral angiography and neurointerventional procedures: a prospective study , 1999, The Lancet.

[32]  L. Calabi,et al.  Gadobenate dimeglumine 0.5 M solution for injection (MultiHance) pharmaceutical formulation and physicochemical properties of a new magnetic resonance imaging contrast medium. , 1999, Journal of computer assisted tomography.

[33]  B K Rutt,et al.  Scanning time efficient slinky for non-contrast MRA at low field. , 1999, Magnetic resonance imaging.

[34]  F. Sardanelli,et al.  MR angiography of internal carotid arteries: breath-hold Gd-enhanced 3D fast imaging with steady-state precession versus unenhanced 2D and 3D time-of-flight techniques. , 1999, Journal of computer assisted tomography.

[35]  L Remonda,et al.  Carotid artery stenosis, occlusion, and pseudo-occlusion: first-pass, gadolinium-enhanced, three-dimensional MR angiography--preliminary study. , 1998, Radiology.

[36]  Z. Bosanac,et al.  Rotational digital subtraction carotid angiography: technique and comparison with static digital subtraction angiography. , 1998, Clinical radiology.

[37]  B K Rutt,et al.  Systematic assessment and evaluation of sliding interleaved ky (SLINKY) acquisition for 3D MRA , 1998, Journal of magnetic resonance imaging : JMRI.

[38]  B. Jenkins,et al.  Gadolinium chelates with weak binding to serum proteins. A new class of high-efficiency, general purpose contrast agents for magnetic resonance imaging. , 1997, Investigative radiology.

[39]  D Saloner,et al.  Assessment of carotid artery stenosis by ultrasonography, conventional angiography, and magnetic resonance angiography: correlation with ex vivo measurement of plaque stenosis. , 1995, Journal of vascular surgery.

[40]  P. Humphrey,et al.  Complications of cerebral angiography in patients with symptomatic carotid territory ischaemia screened by carotid ultrasound. , 1993, Journal of neurology, neurosurgery, and psychiatry.

[41]  D. Sackett,et al.  Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. , 1991, The New England journal of medicine.

[42]  A J Molyneux,et al.  Complications of cerebral angiography for patients with mild carotid territory ischaemia being considered for carotid endarterectomy. , 1990, Journal of neurology, neurosurgery, and psychiatry.