Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, United States of America.
Department of Research Biostatistics, Mayo Clinic Arizona, Phoenix, Arizona, United States of America.
PLoS One. 2020 Sep 2;15(9):e0237856. doi: 10.1371/journal.pone.0237856. eCollection 2020.
MR contrast-enhanced techniques are undergoing increased scrutiny since the FDA applied a warning for gadolinium-based MR contrast agents due to gadolinium deposition within multiple organ systems. While CE-MRA provides excellent image quality, is it required in a screening carotid study? This study compares 2D TOF and 3D TOF MRA vs. CE-MRA in defining carotid stenosis in a large clinical patient population, and with multiple readers with varying experience.
200 consecutive patients had their carotid bifurcations evaluated with 2D TOF, 3D TOF and CE-MRA sequences by 6 board-certified neuroradiologists. Stenosis and quality of examinations were defined for each study. Inter-rater reliability was assessed using two-way random effects intraclass correlation coefficients. Intra-reader reliability was computed via weighted Cohen's κ. Weighted Cohen's κ were also computed to assess agreement in stenosis ratings between enhanced images and unenhanced images.
Agreement between unenhanced and enhanced ratings was substantial with a pooled weighted κ of 0.733 (0.628-0.811). For 5 of the 6 readers, the combination of unenhanced 2D TOF and 3D TOF showed better agreement with contrast-enhanced than either 2D TOF or 3D TOF alone. Intra-reader reliability was substantial.
The combination of 2D TOF and 3D TOF MRA showed substantial agreement with CE-MRA regarding degree of carotid stenosis in this large outpatient population across multiple readers of varying experience. Given the scrutiny that GBCA are undergoing due to concerns regarding CNS and soft tissue deposition, it seems prudent to reserve CE-MRA for cases which are not satisfactorily answered by the nonenhanced study or other noninvasive examinations.
由于 FDA 对钆基磁共振对比剂发出警告，称其可能导致多种器官系统内的钆沉积，磁共振对比增强技术正受到越来越多的审查。CE-MRA 虽然能提供出色的图像质量，但在颈动脉筛查研究中是否必需呢？本研究比较了二维时间飞跃（2D TOF）、三维时间飞跃（3D TOF）MRA 与 CE-MRA 在大型临床患者人群中定义颈动脉狭窄的作用，并由具有不同经验的多位阅片者进行评估。
对 200 例连续患者的颈动脉分叉部进行 2D TOF、3D TOF 和 CE-MRA 序列评估，由 6 位具有神经放射学认证的医师进行评估。对每一项研究中的狭窄程度和检查质量进行定义。使用双向随机效应组内相关系数评估组间可信度。通过加权 Cohen's κ 计算内部可信度。还计算加权 Cohen's κ 以评估增强图像与未增强图像之间的狭窄程度评分的一致性。
未增强与增强评分之间的一致性很高，合并加权κ值为 0.733（0.628-0.811）。对于 6 位阅片者中的 5 位，与单独使用 2D TOF 或 3D TOF 相比，2D TOF 和 3D TOF 的组合与增强图像的一致性更好。内部可信度很高。
在具有不同经验的多位阅片者中，在这个大型门诊患者人群中，2D TOF 和 3D TOF MRA 组合与 CE-MRA 相比，在颈动脉狭窄程度方面具有很高的一致性。鉴于对 GBCA 的审查越来越严格，因为人们担心其可能会导致 CNS 和软组织沉积，因此似乎明智的做法是将 CE-MRA 保留用于非增强研究或其他非侵入性检查无法满意回答的病例。
