Saouaf R, Grassi C J, Hartnell G G, Wheeler H, Suojanen J N
Beth Israel-Deaconess Medical Center, Department of Radiology, and Harvard Medical School, Boston, Massachusetts, USA.
Clin Radiol. 1998 Aug;53(8):579-86. doi: 10.1016/s0009-9260(98)80149-9.
To assess the combination of duplex Doppler ultrasound (DUS) and complete carotid magnetic resonance angiography (MRA) for the non-invasive imaging of carotid disease and their effect on outcomes. Determine inter-reader agreement of carotid MRA.
One-hundred and ten carotid bifurcations were evaluated using DUS, 2D and 3D time-of-flight MRA from the aortic arch to the Circle of Willis in 55 patients. Percentage stenoses were determined by two blinded readers using standardized criteria. Clinical follow-up was by chart review.
Correlation of Doppler and MRA was excellent (r=0.903, P<0.001). Inter-reader agreement (K) for MRA was good: internal carotid artery (ICA) (0.750), external carotid artery (ECA) (0.674) and common carotid artery (CCA) (0.410). Differences in CCA readings were due to minor differences in categorizing lesions as CCA versus ICA or ECA. MRA and Doppler detected nine occluded ICAs. Two DUS occlusions had ICA flow by MRA; one due to a reconstituted precavernous ICA, one a near occluded vessel. Five patients (9%) had surgical management modified by MRA with four not having surgery: three distal ICA/Siphon occlusions and one less severe stenosis by MRA. One tandem lesion not visualized by DUS was surgically significant. Nine aortic arch abnormalities had no surgical impact, possibly due to small sample size. Of 41 endarterectomies, there were no complications from errors of diagnosis.
Carotid MRA correlates well with DUS with good inter-reader agreement. MRA confirms Doppler findings, expands anatomical information and identifies tandem lesions from the aortic arch to the Circle of Willis which can affect surgical management. This approach to carotid artery imaging appears to have no negative effect on surgical outcome.
评估双功能多普勒超声（DUS）与完整的颈动脉磁共振血管造影（MRA）联合用于颈动脉疾病的无创成像及其对治疗结果的影响。确定颈动脉MRA的阅片者间一致性。
对55例患者的110个颈动脉分叉处进行了DUS、二维和三维时间飞跃MRA评估，范围从主动脉弓至Willis环。由两名不知情的阅片者使用标准化标准确定狭窄百分比。通过查阅病历进行临床随访。
多普勒与MRA的相关性极佳（r = 0.903，P < 0.001）。MRA的阅片者间一致性（K）良好：颈内动脉（ICA）为0.750，颈外动脉（ECA）为0.674，颈总动脉（CCA）为0.410。CCA读数的差异是由于将病变分类为CCA与ICA或ECA时存在细微差异。MRA和多普勒检测到9例ICA闭塞。2例DUS显示的ICA闭塞在MRA上有ICA血流；1例是由于海绵窦前ICA重建，1例是血管近乎闭塞。5例患者（9%）的手术治疗因MRA而改变，其中4例未进行手术：3例为远端ICA/虹吸部闭塞，1例MRA显示狭窄程度较轻。1例DUS未显示的串联病变具有手术意义。9例主动脉弓异常对手术无影响，可能是由于样本量小。在41例内膜切除术患者中，没有因诊断错误而出现并发症。
颈动脉MRA与DUS相关性良好，阅片者间一致性良好。MRA证实了多普勒检查结果，扩展了解剖学信息，并识别了从主动脉弓至Willis环的串联病变，这些病变可能影响手术治疗。这种颈动脉成像方法似乎对手术结果没有负面影响。
