TY - JOUR
T1 - Concordance Rate Differences of 3 Noninvasive Imaging Techniques to Measure Carotid Stenosis in Clinical Routine Practice
T2 - Results of the CARMEDAS Multicenter Study
AU - Nonent, Michel
AU - Serfaty, Jean Michel
AU - Nighoghossian, Norbert
AU - Rouhart, François
AU - Derex, Laurent
AU - Rotaru, Carmen
AU - Chirossel, Pierre
AU - Guias, Bruno
AU - Heautot, Jean François
AU - Gouny, Pierre
AU - Langella, Bernard
AU - Buthion, Valérie
AU - Jars, Isabelle
AU - Pachai, Chahin
AU - Veyret, Charles
AU - Gauvrit, Jean Yves
AU - Lamure, Michel
AU - Douek, Philippe C.
PY - 2004/3
Y1 - 2004/3
N2 - 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 ≥50% and ≥70%, for asymptomatic stenosis ≥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.
AB - 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 ≥50% and ≥70%, for asymptomatic stenosis ≥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.
KW - Carotid endarterectomy
KW - Carotid stenosis
KW - Computed tomography
KW - Magnetic resonance angiography
KW - Ultrasonography, Doppler
UR - http://www.scopus.com/inward/record.url?scp=10744225629&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=10744225629&partnerID=8YFLogxK
U2 - 10.1161/01.STR.0000117251.65222.DA
DO - 10.1161/01.STR.0000117251.65222.DA
M3 - Article
C2 - 14764932
AN - SCOPUS:10744225629
SN - 0039-2499
VL - 35
SP - 682
EP - 686
JO - Stroke
JF - Stroke
IS - 3
ER -