PREOPERATIVE ASSESSMENT OF THE CAROTID BIFURCATION - CAN MAGNETIC-RESONANCE ANGIOGRAPHY AND DUPLEX ULTRASONOGRAPHY REPLACE CONTRAST ARTERIOGRAPHY

被引:146
作者
PATEL, MR
KUNTZ, KM
KLUFAS, RA
KIM, D
KRAMER, J
POLAK, JF
SKILLMAN, JJ
WHITTEMORE, AD
EDELMAN, RR
KENT, KC
机构
[1] BETH ISRAEL HOSP,DEPT SURG,BOSTON,MA 02215
[2] BETH ISRAEL HOSP,DEPT RADIOL,BOSTON,MA 02215
[3] HARVARD UNIV,BRIGHAM & WOMENS HOSP,SCH MED,DEPT MED,BOSTON,MA 02115
[4] HARVARD UNIV,BRIGHAM & WOMENS HOSP,SCH MED,DEPT RADIOL,BOSTON,MA 02115
[5] HARVARD UNIV,BRIGHAM & WOMENS HOSP,SCH MED,DEPT SURG,BOSTON,MA 02115
关键词
CAROTID ENDARTERECTOMY; CAROTID STENOSIS; DIAGNOSTIC IMAGING; DUPLEX SCANNING; MAGNETIC RESONANCE IMAGING;
D O I
10.1161/01.STR.26.10.1753
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose Noninvasive studies are used with increasing frequency to assess the carotid bifurcation before endarterectomy. Therefore, assessment of their diagnostic accuracies is essential for appropriate patient management. We prospectively evaluate too noninvasive tests, magnetic resonance angiography (MRA) and duplex ultrasonography (DU), as potential replacements for contrast arteriography (CA). Methods A blinded comparison of three-dimensional time-of-flight (TOF) MRA, two-dimensional TOF MRA, and DU in 176 arteries was performed. CA was used as the standard of comparison. Results Three-dimensional TOF MRA had a sensitivity of 94%, a specificity of 85%, and an accuracy of 88% for the identification of 70% to 99% stenosis, two-dimensional TOF MRA had a sensitivity and specificity that were approximately 10% lower than those of three-dimensional TOF MEW. DU resulted in a sensitivity of 94%, a specificity of 83%, and an accuracy of 86%. Combining data from three-dimensional TOF MRA and DU, allowing for CA only for disparate results, yielded a sensitivity of 100%, a specificity of 91%, and an accuracy of 94% among concordant noninvasive tests, with CA required in 16% of arteries. MRA accurately differentiated 17 carotid occlusions from 16 high-grade (90% to 99%) stenoses, whereas with DU too patent arteries were identified as occluded and one occluded artery was identified as patent. Conclusions Three-dimensional TOF MRA is the most accurate noninvasive test. Combined use of MRA and DU results in a marked increase in accuracy to a level that obviates the need for CA in a majority of patients.
引用
收藏
页码:1753 / 1758
页数:6
相关论文
共 31 条
[21]   CAROTID ENDARTERECTOMY - PREOPERATIVE EVALUATION OF CANDIDATES WITH COMBINED DOPPLER SONOGRAPHY AND MR ANGIOGRAPHY - WORK IN PROGRESS [J].
POLAK, JF ;
KALINA, P ;
DONALDSON, MC ;
OLEARY, DH ;
WHITTEMORE, AD ;
MANNICK, JA .
RADIOLOGY, 1993, 186 (02) :333-338
[22]  
ROEDERER GO, 1983, ARCH SURG-CHICAGO, V118, P1177
[23]  
SCHULER JJ, 1982, SURGERY, V92, P1058
[24]   BETWEEN-METHOD CORRELATION IN QUANTIFYING INTERNAL CAROTID STENOSIS [J].
SITZER, M ;
FURST, G ;
FISCHER, H ;
SIEBLER, M ;
FEHLINGS, T ;
KLEINSCHMIDT, A ;
KAHN, T ;
STEINMETZ, H .
STROKE, 1993, 24 (10) :1513-1518
[25]   ROC ANALYSIS APPLIED TO THE EVALUATION OF MEDICAL IMAGING TECHNIQUES [J].
SWETS, JA .
INVESTIGATIVE RADIOLOGY, 1979, 14 (02) :109-121
[26]   COMBINED USE OF DUPLEX IMAGING AND MAGNETIC-RESONANCE ANGIOGRAPHY FOR EVALUATION OF PATIENTS WITH SYMPTOMATIC IPSILATERAL HIGH-GRADE CAROTID STENOSIS [J].
TURNIPSEED, WD ;
KENNELL, TW ;
TURSKI, PA ;
ACHER, CW ;
HOCH, JR .
JOURNAL OF VASCULAR SURGERY, 1993, 17 (05) :832-840
[27]  
TURNIPSEED WD, 1993, SURGERY, V114, P643
[28]   CEREBROVASCULAR MAGNETIC-RESONANCE ANGIOGRAPHY - A CRITICAL VERIFICATION [J].
WESBEY, GE ;
BERGAN, JJ ;
MORELAND, SI ;
SEDWITZ, MM ;
BARDIN, JA ;
SCHMALBROCK, P ;
LISTERUD, J .
JOURNAL OF VASCULAR SURGERY, 1992, 16 (04) :619-632
[29]  
1991, LANCET, V337, P1235
[30]  
1995, JAMA-J AM MED ASSOC, V273, P1421