Document Detail

Efficacy of patient selection strategies for carotid endarterectomy by contrast-enhanced MRA on a 1 T machine and duplex ultrasound in a regional hospital.
MedLine Citation:
PMID:  18194694     Owner:  NLM     Status:  MEDLINE    
AIM: To investigate whether contrast-enhanced magnetic resonance angiography (CE-MRA) and duplex ultrasound (DUS) could replace digital subtraction angiography (DSA) for diagnosing internal carotid artery (ICA) stenosis in regional centres with less specialized technicians and equipment, such as a 1 Tesla MRI machine. MATERIALS AND METHODS: Sixty-six consecutive, symptomatic patients with ICA stenosis, as evidenced using DSA, were included. In the first 34 patients DUS was validated and cut-off criteria were established. Data were analysed by receiver operating characteristic curve and logistic regression. Two observers analysed the DUS and CE-MRA results of 32 patients. Stenoses were categorized in accordance with North American Symptomatic Endarterectomy Trial (NASCET) measurement criteria. RESULTS: Peak systolic velocity (PSV) in the ICA was defined as a better parameter for defining stenosis than end diastolic velocity and the PSV ICA:common carotid artery ratio. The optimal PSV threshold was 230cm/s. Four ICAs were not interpretable on DUS, and one on CE-MRA. Two patients did not undergo CE-MRA. The sensitivities and specificities were calculated: for DUS these were 100% and 68% respectively; for observer 1 on CE-MRA these were 93% and 89%, respectively; for observer 2 these were 92% and 87%, respectively. The sensitivity and specificity for combined DUS/CE-MRA were 100% and 85%, respectively. Seventy-eight percent of CE-MRA and DUS correlated. The weighted Kappa for CE-MRA and DSA were 0.8 and 0.9, respectively. CONCLUSION: DUS and CE-MRA are effective non-invasive methods for selecting patients with ICA stenosis for carotid endarterectomy in non-specialized centres using a 1T machine. The present results suggest that no referrals to more specialized centres for non-invasive diagnostic work-up for carotid artery stenoses will be necessary.
M A Korteweg; H Kerkhoff; J Bakker; O E H Elgersma
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Publication Detail:
Type:  Journal Article     Date:  2007-10-26
Journal Detail:
Title:  Clinical radiology     Volume:  63     ISSN:  0009-9260     ISO Abbreviation:  Clin Radiol     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-01-15     Completed Date:  2008-03-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1306016     Medline TA:  Clin Radiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  174-83     Citation Subset:  IM    
Department of Radiology, Albert Schweitzer Ziekenhuis locatie Dordwijk, Dordrecht, The Netherlands.
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MeSH Terms
Aged, 80 and over
Angiography, Digital Subtraction
Carotid Stenosis / diagnosis*,  ultrasonography
Contrast Media
Endarterectomy, Carotid / standards*
Hospitals, Teaching
Magnetic Resonance Angiography / instrumentation,  methods,  standards*
Middle Aged
Patient Selection
Prospective Studies
Reproducibility of Results
Sensitivity and Specificity
Ultrasonography, Doppler, Duplex / standards*
Reg. No./Substance:
0/Contrast Media

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