doi: 10.3174/ajnr.A1464
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American Journal of Neuroradiology 30:761-768, April 2009
© 2009 American Society of Neuroradiology
HEAD & NECK
Contrast-Enhanced MR Angiography Is Not More Accurate Than Unenhanced 2D Time-of-Flight MR Angiography for Determining 
70% Internal Carotid Artery Stenosis
a From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
Please address correspondence to Javier M. Romero, MD, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; e-mail: jmromero{at}partners.org
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 
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 70% stenosis. CE-MRA was 84% sensitive and 96% specific for detecting 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 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.