Nonent Michel, Serfaty Jean-Michel, Nighoghossian Norbert, Rouhart François, Derex Laurent, Rotaru Carmen, Chirossel Pierre, Guias Bruno, Heautot Jean-François, Gouny Pierre, Langella Bernard, Buthion Valérie, Jars Isabelle, Pachai Chahin, Veyret Charles, Gauvrit Jean-Yves, Lamure Michel, Douek Philippe C
Department of Radiology, University Hospital Center, Brest, France.
Stroke. 2004 Mar;35(3):682-6. doi: 10.1161/01.STR.0000117251.65222.DA. Epub 2004 Feb 5.
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.
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 > or =50% and > or =70%, for asymptomatic stenosis > or =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.
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).
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.
为在颈动脉狭窄评估中替代数字减影血管造影（DSA），无创成像技术必须达到较高的一致性率。我们的目的是在临床常规实践中比较对比增强磁共振血管造影（CEMRA）和CT血管造影（CTA）与多普勒超声（DUS）的一致性率。
我们前瞻性地用DUS、CEMRA和CTA评估了150例疑似颈动脉狭窄的患者。计算了这三种技术在有症状狭窄≥50%和≥70%、无症状狭窄≥60%以及闭塞情况下的总体一致性率。对于接受手术治疗的颈动脉（n = 97），记录了每种方法和联合技术的结果，并根据手术报告评估错误分类率。
DUS - CEMRA、DUS - CTA和CEMRA - CTA的总体一致性率无统计学差异。然而，在手术无症状狭窄组中，DUS - CEMRA的一致性率（92.53%）显著高于DUS - CTA（79.10%）（P = 0.0258）。与CEMRA（67例中的3例）和DUS（66例中的1例）相比（与MRA相比P = 0.0186，与DUS相比P = 0.0020），单独考虑CTA会在大量手术无症状组病例（64例中的11例）中对狭窄进行错误分类。
根据我们研究中所使用的技术，在临床常规实践中，联合无创方法测量颈动脉狭窄的总体一致性率相似，但在无症状颈动脉狭窄中，如果考虑用DUS和CTA替代DUS和CEMRA，手术决策会显著改变。
