Overestimation of moderate carotid stenosis assessed by both Doppler US and contrast enhanced 3D-MR angiography in the CARMEDAS study

M. Nonent, D. Ben Salem, J. M. Serfaty, V. Buthion, A. Pasco-Papon, C. Rotaru, L. Bressollette, X. Papon, C. Pachai, J. O. Fortrat, P. Gouny, A. Badra, J. Berge, Y. Le Bras, J. P. Cottier, J. Y. Gauvrit, P. Douek

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Purpose: To evaluate the agreement and diagnostic accuracy of Contrast enhanced magnetic resonance angiography (CE-MRA), Doppler ultrasound (DUS) and Digital subtraction angiography (DSA) in the assessment of carotid stenosis. Methods: DUS, CE-MRA and DSA were performed in 56 patients included in the Carotide-angiographie par résonance magnétique-échographie-doppler-angioscanner (CARMEDAS) multicenter study with a carotid stenosis ≥. 50%. Three readers evaluated stenoses on CE-MRA and DSA (NASCET criteria). Velocities criteria were used for stenosis estimation on DUS. Results: CE-MRA had a sensitivity and specificity of 96-98% and 66-83% respectively for carotid stenoses ≥. 50% and a sensitivity and specificity of 94% and 76-84% respectively for carotid stenoses ≥. 70%. The interobserver agreement of CE-MRA was excellent, except for moderate stenoses (50-69%). DUS had a sensitivity and specificity of 88 and 75% respectively for carotid stenoses ≥. 50% and a sensitivity and specificity of 83 and 86% respectively for carotid stenoses ≥. 70%. Combined concordant CE-MRA and DUS had a sensitivity and specificity of 100 and 85-90% respectively for carotid stenoses ≥. 50% and a sensitivity and specificity of 96-100% and 80-87% respectively for carotid stenoses ≥. 70%. The positive predictive value of the association CE-MRA and DUS for carotid stenoses ≥. 70% is calculated between 77 and 82% while the negative predictive value is calculated between 97 and 100%. CE-MRA and DUS have concordant findings in 63-72%, and the overestimations cases were recorded only for carotid stenosis ≤. 69%. Conclusion: Combined DUS-CE-MRA is excellent for evaluation of severe stenosis but remains debatable in moderate stenosis (50-69%) due to the risk of overestimations.

Original languageEnglish (US)
Pages (from-to)148-155
Number of pages8
JournalJournal of Neuroradiology
Volume38
Issue number3
DOIs
StatePublished - Jul 2011
Externally publishedYes

Keywords

  • Angiography
  • Carotid arteries
  • Comparative studies
  • Digital subtraction angiography
  • Magnetic resonance (MR) contrast enhancement
  • Stenosis or occlusion
  • US

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

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