| Contrast-enhanced MR angiography is not more accurate than unenhanced 2D time-of-flight MR angiography for determining > or = 70% internal carotid artery stenosis. | |
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MedLine Citation:
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PMID: 19164440 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: Internal carotid artery (ICA) atheromatous disease is an important cause of ischemic stroke, and endarterectomy or stent placement is typically indicated for symptomatic patients with > or = 70% stenosis. Our purpose was to compare contrast-enhanced MR angiography (CE-MRA) with unenhanced 2D time-of-flight MR angiography (2D TOF MRA) in detecting hemodynamically significant ICA stenosis, by using CT angiography (CTA) as the reference standard. MATERIALS AND METHODS: This was an institutional review board-approved retrospective study. We identified 177 consecutive patients (354 ICAs) who received correlative CE-MRA, 2D TOF MRA, and CTA. Two neuroradiologists blinded to the CTA data graded the degree of ICA stenosis according to a 5-point scale. Additionally, luminal signal-intensity characteristics including 1) signal intensity drop-out, 2) distal-vessel narrowing, and 3) distal-vessel signal-intensity reduction were recorded. MRA results were correlated with those of CTA, and receiver-operating-characteristic (ROC) curves were constructed. RESULTS: On CTA, there were 55 ICAs with and 299 without > or = 70% stenosis. CE-MRA was 84% sensitive and 96% specific for detecting > or = 70% stenosis; 2D TOF MRA was 80% sensitive and 95% specific. The area under the ROC curve was 0.97 for CE-MRA and 0.95 for 2D TOF MRA (P = .51, not significant). For both MRA studies, each of the luminal signal-intensity characteristics had high specificity (> 98%) but poor-to-mild sensitivity (35%-66%) in detecting > or = 70% stenosis. CONCLUSIONS: Although it is established that CE-MRA more accurately delineates neurovascular anatomy than does unenhanced 2D TOF MRA, the administration of gadolinium did not offer a significant advantage in distinguishing surgically treatable ICA stenosis. This conclusion may be important in patients with contraindications to gadolinium. |
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Authors:
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L S Babiarz; J M Romero; E K Murphy; B Brobeck; P W Schaefer; R G González; M H Lev |
Publication Detail:
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Type: Comparative Study; Journal Article; Validation Studies Date: 2009-01-22 |
Journal Detail:
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Title: AJNR. American journal of neuroradiology Volume: 30 ISSN: 1936-959X ISO Abbreviation: AJNR Am J Neuroradiol Publication Date: 2009 Apr |
Date Detail:
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Created Date: 2009-04-08 Completed Date: 2009-06-25 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8003708 Medline TA: AJNR Am J Neuroradiol Country: United States |
Other Details:
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Languages: eng Pagination: 761-8 Citation Subset: IM |
Affiliation:
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Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass. 02114, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Carotid Artery, Internal / pathology Carotid Stenosis / pathology* Contrast Media / diagnostic use* Female Gadolinium / diagnostic use* Humans Magnetic Resonance Angiography / methods*, standards*, statistics & numerical data Male Middle Aged Observer Variation ROC Curve Reference Standards Reproducibility of Results Retrospective Studies Sensitivity and Specificity Young Adult |
| Chemical | |
Reg. No./Substance:
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0/Contrast Media; 7440-54-2/Gadolinium |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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