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<meta name="DC.Title" content="Contrast-Enhanced MR Angiography Is Not More Accurate Than Unenhanced 2D Time-of-Flight MR Angiography for Determining ≥70% Internal Carotid Artery Stenosis" />
<meta name="DC.Identifier" content="10.3174/ajnr.A1464" />
<meta name="DC.Date" content="2009-04-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="Copyright © American Society of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Internal carotid artery (ICA) atheromatous disease is an important cause of ischemic stroke, and endarterectomy or stent placement is typically indicated for symptomatic patients with ≥70% stenosis. Our purpose was to compare contrast-enhanced MR angiography (CE-MRA) with unenhanced 2D time-of-flight MR angiography (2D TOF MRA) in detecting hemodynamically significant ICA stenosis, by using CT angiography (CTA) as the reference standard.

MATERIALS AND METHODS: This was an institutional review board−approved retrospective study. We identified 177 consecutive patients (354 ICAs) who received correlative CE-MRA, 2D TOF MRA, and CTA. Two neuroradiologists blinded to the CTA data graded the degree of ICA stenosis according to a 5-point scale. Additionally, luminal signal-intensity characteristics including 1) signal intensity drop-out, 2) distal-vessel narrowing, and 3) distal-vessel signal-intensity reduction were recorded. MRA results were correlated with those of CTA, and receiver-operating-characteristic (ROC) curves were constructed.

RESULTS: On CTA, there were 55 ICAs with and 299 without ≥70% stenosis. CE-MRA was 84% sensitive and 96% specific for detecting ≥70% stenosis; 2D TOF MRA was 80% sensitive and 95% specific. The area under the ROC curve was 0.97 for CE-MRA and 0.95 for 2D TOF MRA ( P = .51, not significant). For both MRA studies, each of the luminal signal-intensity characteristics had high specificity (&gt;98%) but poor-to-mild sensitivity (35%–66%) in detecting ≥70% stenosis.

CONCLUSIONS: Although it is established that CE-MRA more accurately delineates neurovascular anatomy than does unenhanced 2D TOF MRA, the administration of gadolinium did not offer a significant advantage in distinguishing surgically treatable ICA stenosis. This conclusion may be important in patients with contraindications to gadolinium." />
<meta name="DC.Contributor" content="L.S. Babiarz" />
<meta name="DC.Contributor" content="J.M. Romero" />
<meta name="DC.Contributor" content="E.K. Murphy" />
<meta name="DC.Contributor" content="B. Brobeck" />
<meta name="DC.Contributor" content="P.W. Schaefer" />
<meta name="DC.Contributor" content="R.G. González" />
<meta name="DC.Contributor" content="M.H. Lev" />
<meta name="article:published_time" content="2009-04-01" />
<meta name="article:section" content="HEAD &amp;amp; NECK" />
<meta name="citation_title" content="Contrast-Enhanced MR Angiography Is Not More Accurate Than Unenhanced 2D Time-of-Flight MR Angiography for Determining ≥70% Internal Carotid Artery Stenosis" />
<meta name="citation_abstract" lang="en" content="&lt;p&gt;&lt;b&gt;BACKGROUND AND PURPOSE:&lt;/b&gt; Internal carotid artery (ICA) atheromatous disease is an important cause of ischemic stroke, and endarterectomy or stent placement is typically indicated for symptomatic patients with ≥70% stenosis. Our purpose was to compare contrast-enhanced MR angiography (CE-MRA) with unenhanced 2D time-of-flight MR angiography (2D TOF MRA) in detecting hemodynamically significant ICA stenosis, by using CT angiography (CTA) as the reference standard.&lt;/p&gt;&lt;p&gt;&lt;b&gt;MATERIALS AND METHODS:&lt;/b&gt; This was an institutional review board−approved retrospective study. We identified 177 consecutive patients (354 ICAs) who received correlative CE-MRA, 2D TOF MRA, and CTA. Two neuroradiologists blinded to the CTA data graded the degree of ICA stenosis according to a 5-point scale. Additionally, luminal signal-intensity characteristics including 1) signal intensity drop-out, 2) distal-vessel narrowing, and 3) distal-vessel signal-intensity reduction were recorded. MRA results were correlated with those of CTA, and receiver-operating-characteristic (ROC) curves were constructed.&lt;/p&gt;&lt;p&gt;&lt;b&gt;RESULTS:&lt;/b&gt; On CTA, there were 55 ICAs with and 299 without ≥70% stenosis. CE-MRA was 84% sensitive and 96% specific for detecting ≥70% stenosis; 2D TOF MRA was 80% sensitive and 95% specific. The area under the ROC curve was 0.97 for CE-MRA and 0.95 for 2D TOF MRA (&lt;i&gt;P&lt;/i&gt; = .51, not significant). For both MRA studies, each of the luminal signal-intensity characteristics had high specificity (&amp;gt;98%) but poor-to-mild sensitivity (35%–66%) in detecting ≥70% stenosis.&lt;/p&gt;&lt;p&gt;&lt;b&gt;CONCLUSIONS:&lt;/b&gt; Although it is established that CE-MRA more accurately delineates neurovascular anatomy than does unenhanced 2D TOF MRA, the administration of gadolinium did not offer a significant advantage in distinguishing surgically treatable ICA stenosis. This conclusion may be important in patients with contraindications to gadolinium.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_reference" content="citation_title=New England Journal of Medicine;citation_journal_abbrev=NEJM;citation_title=Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators;citation_pages=445-453;citation_volume=325;citation_year=1991;citation_issue=7;citation_issn=0028-4793;citation_pmid=1852179;citation_doi=10.1056/NEJM199108153250701" />
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<meta name="twitter:title" content="Contrast-Enhanced MR Angiography Is Not More Accurate Than Unenhanced 2D Time-of-Flight MR Angiography for Determining ≥70% Internal Carotid Artery Stenosis" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Internal carotid artery (ICA) atheromatous disease is an important cause of ischemic stroke, and endarterectomy or stent placement is typically indicated for symptomatic patients with ≥70% stenosis. Our purpose was to compare contrast-enhanced MR angiography (CE-MRA) with unenhanced 2D time-of-flight MR angiography (2D TOF MRA) in detecting hemodynamically significant ICA stenosis, by using CT angiography (CTA) as the reference standard.

MATERIALS AND METHODS: This was an institutional review board−approved retrospective study. We identified 177 consecutive patients (354 ICAs) who received correlative CE-MRA, 2D TOF MRA, and CTA. Two neuroradiologists blinded to the CTA data graded the degree of ICA stenosis according to a 5-point scale. Additionally, luminal signal-intensity characteristics including 1) signal intensity drop-out, 2) distal-vessel narrowing, and 3) distal-vessel signal-intensity reduction were recorded. MRA results were correlated with those of CTA, and receiver-operating-characteristic (ROC) curves were constructed.

RESULTS: On CTA, there were 55 ICAs with and 299 without ≥70% stenosis. CE-MRA was 84% sensitive and 96% specific for detecting ≥70% stenosis; 2D TOF MRA was 80% sensitive and 95% specific. The area under the ROC curve was 0.97 for CE-MRA and 0.95 for 2D TOF MRA ( P = .51, not significant). For both MRA studies, each of the luminal signal-intensity characteristics had high specificity (&gt;98%) but poor-to-mild sensitivity (35%–66%) in detecting ≥70% stenosis.

CONCLUSIONS: Although it is established that CE-MRA more accurately delineates neurovascular anatomy than does unenhanced 2D TOF MRA, the administration of gadolinium did not offer a significant advantage in distinguishing surgically treatable ICA stenosis. This conclusion may be important in patients with contraindications to gadolinium." />
<meta name="og-title" property="og:title" content="Contrast-Enhanced MR Angiography Is Not More Accurate Than Unenhanced 2D Time-of-Flight MR Angiography for Determining ≥70% Internal Carotid Artery Stenosis" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/30/4/761" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Internal carotid artery (ICA) atheromatous disease is an important cause of ischemic stroke, and endarterectomy or stent placement is typically indicated for symptomatic patients with ≥70% stenosis. Our purpose was to compare contrast-enhanced MR angiography (CE-MRA) with unenhanced 2D time-of-flight MR angiography (2D TOF MRA) in detecting hemodynamically significant ICA stenosis, by using CT angiography (CTA) as the reference standard.

MATERIALS AND METHODS: This was an institutional review board−approved retrospective study. We identified 177 consecutive patients (354 ICAs) who received correlative CE-MRA, 2D TOF MRA, and CTA. Two neuroradiologists blinded to the CTA data graded the degree of ICA stenosis according to a 5-point scale. Additionally, luminal signal-intensity characteristics including 1) signal intensity drop-out, 2) distal-vessel narrowing, and 3) distal-vessel signal-intensity reduction were recorded. MRA results were correlated with those of CTA, and receiver-operating-characteristic (ROC) curves were constructed.

RESULTS: On CTA, there were 55 ICAs with and 299 without ≥70% stenosis. CE-MRA was 84% sensitive and 96% specific for detecting ≥70% stenosis; 2D TOF MRA was 80% sensitive and 95% specific. The area under the ROC curve was 0.97 for CE-MRA and 0.95 for 2D TOF MRA ( P = .51, not significant). For both MRA studies, each of the luminal signal-intensity characteristics had high specificity (&gt;98%) but poor-to-mild sensitivity (35%–66%) in detecting ≥70% stenosis.

CONCLUSIONS: Although it is established that CE-MRA more accurately delineates neurovascular anatomy than does unenhanced 2D TOF MRA, the administration of gadolinium did not offer a significant advantage in distinguishing surgically treatable ICA stenosis. This conclusion may be important in patients with contraindications to gadolinium." />
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    <title>Contrast-Enhanced MR Angiography Is Not More Accurate Than Unenhanced 2D Time-of-Flight MR Angiography for Determining ≥70% Internal Carotid Artery Stenosis | American Journal of Neuroradiology</title>  
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node7696--5" data-node-nid="7696" id="top-node-7696--61235357132" data-pisa="ajnr;30/4/761" data-pisa-master="ajnr;ajnr.A1464" data-apath="/ajnr/30/4/761.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
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      <h1 class="highwire-cite-title" id="page-title">Contrast-Enhanced MR Angiography Is Not More Accurate Than Unenhanced 2D Time-of-Flight MR Angiography for Determining ≥70% Internal Carotid Artery Stenosis</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">L.S. Babiarz</span>, <span class="highwire-citation-author" data-delta="1">J.M. Romero</span>, <span class="highwire-citation-author" data-delta="2">E.K. Murphy</span>, <span class="highwire-citation-author" data-delta="3">B. Brobeck</span>, <span class="highwire-citation-author" data-delta="4">P.W. Schaefer</span>, <span class="highwire-citation-author" data-delta="5">R.G. González</span> and <span class="highwire-citation-author" data-delta="6">M.H. Lev</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">April 2009,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">30 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">761-768; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A1464 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-7696--61235357132" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">L.S. Babiarz </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=L.S.%2BBabiarz%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Babiarz%20L&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AL.S.%2BBabiarz%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">J.M. 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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">L.S.</span> <span class="nlm-surname">Babiarz</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">J.M.</span> <span class="nlm-surname">Romero</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">E.K.</span> <span class="nlm-surname">Murphy</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">B.</span> <span class="nlm-surname">Brobeck</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">P.W.</span> <span class="nlm-surname">Schaefer</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">R.G.</span> <span class="nlm-surname">González</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">M.H.</span> <span class="nlm-surname">Lev</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Apr 2009, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">30 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">761-768; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A1464 </span></div>
  
  
  
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      <div class="highwire-cite-title">Contrast-Enhanced MR Angiography Is Not More Accurate Than Unenhanced 2D Time-of-Flight MR Angiography for Determining ≥70% Internal Carotid Artery Stenosis</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">L.S.</span> <span class="nlm-surname">Babiarz</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">J.M.</span> <span class="nlm-surname">Romero</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">E.K.</span> <span class="nlm-surname">Murphy</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">B.</span> <span class="nlm-surname">Brobeck</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">P.W.</span> <span class="nlm-surname">Schaefer</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">R.G.</span> <span class="nlm-surname">González</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">M.H.</span> <span class="nlm-surname">Lev</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Apr 2009, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">30 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">761-768; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A1464 </span></div>
  
  
  
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