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Contrast-enhanced magnetic resonance angiography of carotid arteries: utility in routine clinical practice.

Publication ,  Journal Article
Johnston, DCC; Eastwood, JD; Nguyen, T; Goldstein, LB
Published in: Stroke
December 2002

BACKGROUND AND PURPOSE: Contrast-enhanced magnetic resonance angiography (CEMRA) is among the newer noninvasive tests used for the evaluation of patients with carotid artery disease. Evidence supporting its utility in routine clinical practice is lacking. METHODS: The results of CEMRA were compared with those of catheter angiography in 50 consecutive patients being evaluated for carotid endarterectomy (CEA) at a community hospital. Using indications for CEA based on published guidelines, we determined the rate of misclassification for surgery, sensitivity, specificity, and positive and negative predictive values. In addition, the interrater agreement (kappa score) of CEMRA was compared with that of catheter angiography in the studied population and with interpretations provided by 2 blinded radiologists. RESULTS: Compared with catheter angiography, 24% (95% CI, 12% to 36%) of patients would have been misclassified for CEA on the basis of CEMRA results alone. CEMRA was associated with sensitivity of 92%, specificity of 62%, positive predictive value of 78%, and negative predictive value of 89%. When both CEMRA and duplex Doppler ultrasound were performed and the results were concordant, the misclassification rate decreased to 17% (95% CI, 2% to 32%). kappa scores were similar for CEMRA and catheter angiography (0.72 and 0.75, respectively). CONCLUSIONS: CEMRA was found to be highly sensitive for detection of surgically amenable carotid stenosis. kappa scores for the interpretation of CEMRA and catheter angiography were similar. However, clinicians should be cautious when using CEMRA alone for surgical decision making in CEA candidates because a significant number of patients may be misclassified. The rate of misclassification is reduced when the results of CEMRA and duplex Doppler ultrasound are concordant.

Duke Scholars

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

December 2002

Volume

33

Issue

12

Start / End Page

2834 / 2838

Location

United States

Related Subject Headings

  • Ultrasonography, Doppler, Duplex
  • Sensitivity and Specificity
  • Reproducibility of Results
  • ROC Curve
  • Predictive Value of Tests
  • Patient Selection
  • Observer Variation
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Johnston, D. C. C., Eastwood, J. D., Nguyen, T., & Goldstein, L. B. (2002). Contrast-enhanced magnetic resonance angiography of carotid arteries: utility in routine clinical practice. Stroke, 33(12), 2834–2838. https://doi.org/10.1161/01.str.0000043632.51378.24
Johnston, Dean C. C., James D. Eastwood, Thanh Nguyen, and Larry B. Goldstein. “Contrast-enhanced magnetic resonance angiography of carotid arteries: utility in routine clinical practice.Stroke 33, no. 12 (December 2002): 2834–38. https://doi.org/10.1161/01.str.0000043632.51378.24.
Johnston DCC, Eastwood JD, Nguyen T, Goldstein LB. Contrast-enhanced magnetic resonance angiography of carotid arteries: utility in routine clinical practice. Stroke. 2002 Dec;33(12):2834–8.
Johnston, Dean C. C., et al. “Contrast-enhanced magnetic resonance angiography of carotid arteries: utility in routine clinical practice.Stroke, vol. 33, no. 12, Dec. 2002, pp. 2834–38. Pubmed, doi:10.1161/01.str.0000043632.51378.24.
Johnston DCC, Eastwood JD, Nguyen T, Goldstein LB. Contrast-enhanced magnetic resonance angiography of carotid arteries: utility in routine clinical practice. Stroke. 2002 Dec;33(12):2834–2838.

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

December 2002

Volume

33

Issue

12

Start / End Page

2834 / 2838

Location

United States

Related Subject Headings

  • Ultrasonography, Doppler, Duplex
  • Sensitivity and Specificity
  • Reproducibility of Results
  • ROC Curve
  • Predictive Value of Tests
  • Patient Selection
  • Observer Variation
  • Neurology & Neurosurgery
  • Middle Aged
  • Male