To evaluate the agreement and diagnostic accuracy of Contrast enhanced magnetic resonance angiography (CE-MRA), Doppler ultrasound (DUS) and Digital subtraction angiography (DSA) in the assessment of carotid stenosis.
DUS, CE-MRA and DSA were performed in 56 patients included in the Carotide-angiographie par résonance magnétique-échographie-doppler-angioscanner (CARMEDAS) multicenter study with a carotid stenosis ≥50%. Three readers evaluated stenoses on CE-MRA and DSA (NASCET criteria). Velocities criteria were used for stenosis estimation on DUS.
CE-MRA had a sensitivity and specificity of 96–98% and 66–83% respectively for carotid stenoses ≥50% and a sensitivity and specificity of 94% and 76–84% respectively for carotid stenoses ≥70%. The interobserver agreement of CE-MRA was excellent, except for moderate stenoses (50–69%). DUS had a sensitivity and specificity of 88 and 75% respectively for carotid stenoses ≥50% and a sensitivity and specificity of 83 and 86% respectively for carotid stenoses ≥70%. Combined concordant CE-MRA and DUS had a sensitivity and specificity of 100 and 85–90% respectively for carotid stenoses ≥50% and a sensitivity and specificity of 96–100% and 80–87% respectively for carotid stenoses ≥70%. The positive predictive value of the association CE-MRA and DUS for carotid stenoses ≥70% is calculated between 77 and 82% while the negative predictive value is calculated between 97 and 100%. CE-MRA and DUS have concordant findings in 63–72%, and the overestimations cases were recorded only for carotid stenosis ≤69%.
Combined DUS–CE-MRA is excellent for evaluation of severe stenosis but remains debatable in moderate stenosis (50–69%) due to the risk of overestimations.Le texte complet de cet article est disponible en PDF.
Keywords : Angiography, Comparative studies, Carotid arteries, Stenosis or occlusion, Magnetic resonance (MR) contrast enhancement, Digital subtraction angiography, Carotid arteries, US