Department of Radiology, University Hospital Center, hôpital de la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest cedex, France.
J Neuroradiol. 2011 Jul;38(3):148-55. doi: 10.1016/j.neurad.2010.05.002. Epub 2010 Aug 21.
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.
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.
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%.
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.
评估对比增强磁共振血管造影（CE-MRA）、多普勒超声（DUS）和数字减影血管造影（DSA）在评估颈动脉狭窄中的一致性和诊断准确性。
在 Carotide-angiographie par résonance magnétique-échographie-doppler-angioscanner（CARMEDAS）多中心研究中，对 56 例颈动脉狭窄≥50%的患者进行了 DUS、CE-MRA 和 DSA 检查。三位读者根据 NASCET 标准评估 CE-MRA 和 DSA 的狭窄程度。使用流速标准评估 DUS 狭窄程度。
CE-MRA 对颈动脉狭窄≥50%的敏感性和特异性分别为 96-98%和 66-83%，对颈动脉狭窄≥70%的敏感性和特异性分别为 94%和 76-84%。CE-MRA 的观察者间一致性很好，除了中度狭窄（50-69%）。DUS 对颈动脉狭窄≥50%的敏感性和特异性分别为 88%和 75%，对颈动脉狭窄≥70%的敏感性和特异性分别为 83%和 86%。联合一致的 CE-MRA 和 DUS 对颈动脉狭窄≥50%的敏感性和特异性分别为 100%和 85-90%，对颈动脉狭窄≥70%的敏感性和特异性分别为 96-100%和 80-87%。CE-MRA 和 DUS 联合对颈动脉狭窄≥70%的阳性预测值在 77%至 82%之间，阴性预测值在 97%至 100%之间。CE-MRA 和 DUS 的一致性在 63-72%之间，仅在颈动脉狭窄≤69%时记录到高估病例。
联合 DUS-CE-MRA 非常适合评估严重狭窄，但在中度狭窄（50-69%）中仍存在争议，因为存在高估的风险。
