Abstract
Purpose
The aim of this study was to compare the diagnostic accuracy of 3D time-of-flight (TOF-MRA) and contrast-enhanced (CE-MRA) magnetic resonance angiography at 3 T for detection and quantification of proximal high-grade stenosis using multidetector computed tomography angiography (MDCTA) as reference standard.
Methods
The institutional ethics committee approved this prospective study. A total of 41 patients suspected of having internal carotid artery (ICA) stenosis underwent both MDCTA and MRA. CE-MRA and TOF-MRA were performed using a 3.0-T imager with a dedicated eight-element cervical coil. ICA stenoses were measured according to the North American Symptomatic Carotid Endarterectomy Trial criteria and categorized as 0–25 % (minimal), 25–50 % (mild), 50–69 % (moderate), 70–99 % (high grade), and 100 % (occlusion). Sensitivity and specificity for the detection of high-grade ICA stenoses (70–99 %) and ICA occlusions were determined. In addition, intermodality agreement was assessed with κ-statistics for detection of high-grade ICA stenoses (70–99 %) and ICA occlusions.
Results
A total of 80 carotid arteries of 41 patients were reviewed. Two previously stented ICAs were excluded from analysis. On MDCTA, 7 ICAs were occluded, 12 ICAs presented with and 63 without a high-grade ICA stenosis (70–99 %). For detecting 70–99 % stenosis, both 3D TOF-MRA and CE-MRA were 91.7 % sensitive and 98.5 % specific, respectively. Both MRA techniques were highly sensitive (100 %), and specific (CE-MRA, 100 %; TOF-MRA, 98.7 %) for the detection of ICA occlusion. However, TOF-MRA misclassified one high-grade stenosis as occlusion. Intermodality agreement for detection of 70–99 % ICA stenoses was excellent between TOF-MRA and CE-MRA [κ = 0.902, 95 % confidence interval (CI) = 0.769–1.000], TOF-MRA and MDCTA (κ = 0.902, 95 % CI = 0.769–1.000), and CE-MRA and MDCTA (κ = 0.902, 95 % CI = 0.769–1.000).
Conclusion
Both 3D TOF-MRA and CE-MRA at 3 T are reliable tools for detecting high-grade proximal ICA stenoses (70–99 %). 3D TOF-MRA might misclassify pseudo-occlusions as complete occlusions. If there are no contraindications for CE-MRA, CE-MRA is recommended as primary MR imaging modality.
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Abbreviations
- CCA:
-
Common carotid artery
- CE-MRA:
-
Contrast-enhanced magnetic resonance angiography
- CI:
-
Confidence interval
- CNR:
-
Contrast-to-noise ratio
- DSA:
-
Digital subtraction angiography
- GRAPPA:
-
Generalized Autocalibrating Partially Parallel Acquisition
- HU:
-
Houndsfield Units
- ICA:
-
Internal carotid artery
- MDCTA:
-
Multidetector CTA
- MIP:
-
Maximum Intensity Projection
- NASCET:
-
North American Symptomatic Carotid Endarterectomy Trial
- ROI:
-
Region of interest
- SNR:
-
Signal-to-noise ratio
- TOF-MRA:
-
Time-of-flight magnetic resonance angiography
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Weber, J., Veith, P., Jung, B. et al. MR Angiography at 3 Tesla to Assess Proximal Internal Carotid Artery Stenoses: Contrast-Enhanced or 3D Time-of-Flight MR Angiography?. Clin Neuroradiol 25, 41–48 (2015). https://doi.org/10.1007/s00062-013-0279-x
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DOI: https://doi.org/10.1007/s00062-013-0279-x