Concordance rate differences of 3 noninvasive imaging techniques to measure carotid stenosis in clinical routine practice - Results of the CARMEDAS Multicenter Study

Background and Purpose - To replace digital subtraction angiography (DSA) in carotid stenosis evaluation, noninvasive imaging techniques have to reach a high concordance rate. Our purpose is to compare the concordance rates of contrast-enhanced MR angiography (CEMRA) and CT angiography (CTA) with Doppler ultrasound (DUS) in clinical routine practice. Methods - We evaluated prospectively with DUS, CEMRA, and CTA 150 patients suspected of carotid stenosis. The overall concordance rates of the 3 techniques were calculated for symptomatic stenosis greater than or equal to 50% and greater than or equal to 70%, for asymptomatic stenosis greater than or equal to 60%, and for occlusion. For the carotid arteries treated by surgery (n = 97), the results of each method and combined techniques were recorded, and misclassification rates were evaluated from surgical reports. Results - The overall concordance rates of DUS-CEMRA, DUS-CTA, and CEMRA-CTA were not statistically different. However, the concordance rate of DUS-CEMRA (92.53%) was significantly higher than that for DUS-CTA (79.10%) in the surgical asymptomatic stenosis group ( P = 0.0258). CTA considered alone would misclassify the stenosis in a significant number of cases ( 11 of 64) in the surgical asymptomatic group compared with CEMRA ( 3 of 67) and DUS (1 of 66) (P = 0.0186 versus MRA, P = 0.0020 versus DUS). Conclusions - With the techniques as utilized in our study, the overall concordance rates of combined noninvasive methods are similar for measuring carotid stenosis in clinical routine practice, but in asymptomatic carotid stenosis, the decision making for surgery is significantly altered if DUS and CTA are considered in place of DUS and CEMRA.