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Overestimation of moderate carotid stenosis assessed by both Doppler US and contrast enhanced 3D-MR angiography in the CARMEDAS study - 01/07/11

Doi : 10.1016/j.neurad.2010.05.002 
M. Nonent a, b, D. Ben Salem b, , J.-M. Serfaty c, V. Buthion d, A. Pasco-Papon e, C. Rotaru f, L. Bressollette g, X. Papon h, C. Pachai i, J.-O. Fortrat j, P. Gouny k, A. Badra k, J. Berge l, Y. Le Bras m, J.-P. Cottier n, J.Y. Gauvrit o, P. Douek f
a Department of Radiology, University Hospital Center, hôpital de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest cedex, France 
b EA3878, groupe d’étude de la thrombose de Bretagne occidentale (GETBO), hôpital de la Cavale-Blanche, université Européenne de Bretagne, Brest, France 
c UMR CNRS 5824, department of Radiology, Bichat University Hospital, Paris, France 
d Health Systems Analysis Laboratory (Gate), University of Lyon, Ecully, France 
e Department of Neuroradiology, University Hospital Center, Angers, France 
f UMR CNRS 5220 – Inserm U630 Creatis, Lyon, France 
g Vascular Medicine Department, University Hospital Center, Brest, France 
h Vascular Surgery Department, University Hospital Center, Angers, France 
i Bioclinica SAS (Theralys®), Lyon, France 
j Angiology Department, University Hospital Center, Angers, France 
k Vascular Surgery Department, University Hospital Center, Brest, France 
l Department of Neuroradiology, University Hospital Center, Bordeaux, France 
m Department of Radiology, Hospital Center, Niort, France 
n Department of Neuroradiology, VisAGeS - U746, University Hospital Center, Tours, France 
o Department of Neuroradiology, University Hospital Center, Rennes, France 

Corresponding author.

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Summary

Purpose

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.

Methods

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.

Results

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%.

Conclusion

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.

El texto completo de este artículo está disponible en PDF.

Keywords : Angiography, Comparative studies, Carotid arteries, Stenosis or occlusion, Magnetic resonance (MR) contrast enhancement, Digital subtraction angiography, Carotid arteries, US


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© 2010  Elsevier Masson SAS. Reservados todos los derechos.
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Vol 38 - N° 3

P. 148-155 - juillet 2011 Regresar al número
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