American Journal of Neuroradiology 26:1012-1021, May 2005
© 2005 American Society of Neuroradiology
BRAIN
Intracranial Vascular Stenosis and Occlusive Disease: Evaluation with CT Angiography, MR Angiography, and Digital Subtraction Angiography
a Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles
b Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles
Address correspondence to Suzie Bash, MD, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, BL-133C/CHS, Los Angeles, CA 90095-1721
BACKGROUND AND PURPOSE: Although digital subtraction angiography (DSA) provides excellent visualization of the intracranial vasculature, it has several limitations. Our purpose was to evaluate the ability of helical CT angiography (CTA) to help detect and quantify intracranial stenosis and occlusion compared with DSA and MR angiography (MRA).
METHODS: Twenty-eight patients underwent CTA, DSA, and 3D time-of-flight (TOF) MRA for suspected cerebrovascular lesions. All three studies were performed within a 30-day period. Two readers blinded to prior estimated or calculated stenoses, patient history and clinical information examined 672 vessel segments. Lesions were categorized as normal (0–9%), mild (10–29%), moderate (30–69%), severe (70–99%), or occluded (no flow detected). DSA was the reference standard. Unblinded consensus readings were obtained for all discrepancies.
RESULTS: A total of 115 diseased vessel segments were identified. After consensus interpretation, CTA revealed higher sensitivity than that of MRA for intracranial stenosis (98% versus 70%, P < .001) and occlusion (100% versus 87%, P = .02). CTA had a higher positive predictive value than that of MRA for both stenosis (93% versus 65%, P < .001) and occlusion (100% versus 59%, P < .001). CTA had a high interoperator reliability. In 6 of 28 patients (21%), all 6 with low-flow states in the posterior circulation, CTA was superior to DSA in detection of vessel patency.
CONCLUSION: CTA has a higher sensitivity and positive predictive value than MRA and is recommended over TOF MRA for detection of intracranial stenosis and occlusion. CTA has a high interoperator reliability. CTA is superior to DSA in the evaluation of posterior circulation steno-occlusive disease when slow flow is present. CTA results had a significant effect on patient clinical management.
This article has been cited by other articles:
 |
|
 |
|
  R. Manniesing, M. A. Viergever, A. van der Lugt, and W. J. Niessen Cerebral Arteries: Fully Automated Segmentation from CT Angiography--A Feasibility Study Radiology, June 1, 2008; 247(3): 841 - 846. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. N. Nguyen-Huynh, M. Wintermark, J. English, J. Lam, E. Vittinghoff, W. S. Smith, and S. C. Johnston How Accurate Is CT Angiography in Evaluating Intracranial Atherosclerotic Disease? Stroke, April 1, 2008; 39(4): 1184 - 1188. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. K. Sharma, G. Tsivgoulis, A. Y. Lao, M. D. Malkoff, and A. V. Alexandrov Noninvasive Detection of Diffuse Intracranial Disease Stroke, December 1, 2007; 38(12): 3175 - 3181. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. M. Kramer, M. J. Budoff, Z. A. Fayad, V. A. Ferrari, C. Goldman, J. R. Lesser, E. T. Martin, S. Rajagopalan, J. P. Reilly, G. P. Rodgers, et al. ACCF/AHA 2007 Clinical Competence Statement on vascular imaging with computed tomography and magnetic resonance Vascular Medicine, November 1, 2007; 12(4): 359 - 378. [PDF]
|
|
|
|
 |
|
 S Khan, G C Cloud, S Kerry, and H S Markus Imaging of vertebral artery stenosis: a systematic review J. Neurol. Neurosurg. Psychiatry, November 1, 2007; 78(11): 1218 - 1225. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. M. Kramer, M. J. Budoff, Z. A. Fayad, V. A. Ferrari, C. Goldman, J. R. Lesser, E. T. Martin, S. Rajagopalan, J. P. Reilly, G. P. Rodgers, et al. ACCF/AHA 2007 Clinical Competence Statement on Vascular Imaging With Computed Tomography and Magnetic Resonance: A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training Developed in Collaboration With the Society of Atherosclerosis Imaging and Prevention, the Society for Cardiovascular Angiography and Interventions, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society for Vascular Medicine and Biology J. Am. Coll. Cardiol., September 11, 2007; 50(11): 1097 - 1114. [Full Text] [PDF]
|
|
|
|
 |
|
 M. D. Hill, A. M. Demchuk, and R. Frayne Noninvasive imaging is improving but digital subtraction angiography remains the gold standard Neurology, June 12, 2007; 68(24): 2057 - 2058. [Full Text] [PDF]
|
|
|
|
|
|
E. Feldmann, J. L. Wilterdink, A. Kosinski, M. Lynn, M. I. Chimowitz, J. Sarafin, H. H. Smith, F. Nichols, J. Rogg, H. J. Cloft, et al. The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) Trial Neurology, June 12, 2007; 68(24): 2099 - 2106. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C.G. Choi, D.H. Lee, J.H. Lee, H.W. Pyun, D.W. Kang, S.U. Kwon, J.K. Kim, S.J. Kim, and D.C. Suh Detection of Intracranial Atherosclerotic Steno-Occlusive Disease with 3D Time-of-Flight Magnetic Resonance Angiography with Sensitivity Encoding at 3T AJNR Am. J. Neuroradiol., March 1, 2007; 28(3): 439 - 446. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. P. Villablanca, F. J. Rodriguez, T. Stockman, S. Dahliwal, M. Omura, S. Hazany, and J. Sayre MDCT Angiography for Detection and Quantification of Small Intracranial Arteries: Comparison with Conventional Catheter Angiography Am. J. Roentgenol., February 1, 2007; 188(2): 593 - 602. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Lell, C. Fellner, U. Baum, T. Hothorn, R. Steiner, W. Lang, W. Bautz, and F.A. Fellner Evaluation of Carotid Artery Stenosis with Multisection CT and MR Imaging: Influence of Imaging Modality and Postprocessing AJNR Am. J. Neuroradiol., January 1, 2007; 28(1): 104 - 110. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. M. Lell, K. Anders, M. Uder, E. Klotz, H. Ditt, F. Vega-Higuera, T. Boskamp, W. A. Bautz, and B. F. Tomandl New Techniques in CT Angiography RadioGraphics, October 1, 2006; 26(suppl_1): S45 - S62. [Abstract] [Full Text] [PDF]
|
|