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Diagnostic accuracy of colour Doppler ultrasonography, CT angiography and blood-pool-enhanced MR angiography in assessing carotid stenosis: a comparative study with DSA in 170 patients

Accuratezza diagnostica nella valutazione della stenosi carotidea di eco-color Doppler, angio-TC ed angio-RM con mezzo di contrasto intravascolare: valutazione comparativa dell’accuratezza diagnostica con DSA in 170 pazienti

  • Vascular and Interventional Radiology / Radiologia Vascolare e Interventistica
  • Published:
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Abstract

Purpose

This study was undertaken to prospectively evaluate the diagnostic performance of colour Doppler ultrasonography (CDUS), first-pass (FP) and steady-state (SS) contrast-enhanced magnetic resonance angiography (MRA) and computed tomography angiography (CTA) of the carotid arteries using digital subtraction angiography (DSA) as the reference standard.

Materials and methods

A total of 170 patients with previous cerebrovascular events and suspected carotid artery stenoses underwent CDUS, blood-pool MRA, CTA and DSA. Accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for CDUS, FP MRA, SS MRA and CTA. The McNemar and Wilcoxon tests and receiver operating characteristic (ROC) curve analysis were used to determine significant differences (p<0.05) between the diagnostic performances of the four modalities, and the degree of stenosis was compared using linear regression.

Results

A total of 336 carotid bifurcations were studied. The area under the curve (AUC) for degree of stenosis was: CDUS 0.85±0.02, FP MRA 0.982±0.005, SS MRA 0.994±0.002 and CTA 0.997±0.001. AUC analysis showed no statistically significant difference between CTA and MRA (p=0.0174) and a statistically significant difference between CDUS and the other techniques (p<0.001). Plaque morphology analysis showed no significant difference between CTA and SS MRA; a significant difference was seen between CTA and SS MRA versus FP MRA (p=0.04) and CDUS (p=0.038). Plaque ulceration analysis showed a statistically significant difference between MRA and CTA (0.04< p<0.046) versus CDUS (p=0.019).

Conclusions

CTA is the most accurate technique for evaluating carotid stenoses, with a slightly better performance than MRA (97% vs. 95% for SS MRA and 92% for FP MRA) and a greater accuracy than CDUS (97% vs. 76%). Blood-pool contrast-enhanced SS sequences offer improved evaluation of degree of stenosis and plaque morphology with accuracy substantially identical to CTA.

Riassunto

Obiettivo

L’obiettivo di questo studio è stato di valutare prospetticamente l’accuratezza dell’eco-color Doppler (ECD), dell’angiografia con risonanza magnetica (angio-RM), ottenuta con sequenze di primo passaggio (PP) ed allo stato stazionario (SS) e dell’angiografia con tomografia computerizzata (angio-TC) nella diagnostica della stenosi carotidea utilizzando l’angiografia con sottrazione digitale (DSA) come metodica di riferimento.

Materiali e metodi

Centosettanta pazienti sintomatici e con sospetta stenosi carotidea sono stati sottoposti ad ECD, angio-RM, angio-TC e DSA. Accuratezza, sensibilità, specificità, valore predittivo positivo (VPP) e valore predittivo negativo (VPN) sono stati calcolati per ECD, angio-RM ed angio-TC. Le differenze di performance tra le metodiche sono state valutate utilizzando il test di McNemar, il test di Wilcoxon e l’analisi delle curve receiver operating characteristic (ROC) (p<0,05). Inoltre il valore di stenosi attribuito dalla valutazione dell’ECD, dell’angio-RM e dell’angio-TC è stato confrontato con il valore della DSA tramite regressioni lineari.

Risultati

Sono state valutate 336 biforcazioni carotidee. Per la valutazione del grado di stenosi è stata calcolata l’area sotto la curva (AUC) delle quattro metodiche che è risultata: ECD 0,85±0,02, angio-RM PP=0,982±0,005, angio-RM SS=0,994±0,002 ed angio-TC=0,997±0,001 con sostanziale equivalenza tra angio-TC ed angio-RM (p=0,0174) ed una differenza statisticamente significativatra l’ECD e le altre metodiche (p<0,001). Per la valutazione della morfologia di placca l’analisi delle AUC delle quattro metodiche ha evidenziato una sostanziale equivalenza tra angio-TC ed angio-RM con SS, ma ha evidenziato una lieve differenza di entrambe le metodiche nei confronti dell’angio-RM con PP (p=0,04) e dell’ECD (p=0,038). La valutazione delle ulcere ha evidenziato una differenza statisticamente significativa tra l’angio-RM e l’angio-TC (p=0,04–0,046) e l’ECD (p=0,019).

Conclusioni

L’angio-TC è la metodica più affidabile con una leggera superiorità diagnostica rispetto all’angio-RM (97% vs. 95% per le sequenze SS e 92% per le sequenze PP) ed una superiorità molto marcata rispetto all’ECD (97% vs. 76%). L’angio-RM con l’utilizzo delle sequenze allo stato stazionario ottenute con mezzo di contrasto intravascolare ad alta relassività tende sostanzialmente ad eguagliare l’accuratezza dell’angio-TC.

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Authors and Affiliations

  1. Department of Radiological Sciences, University of Rome “La Sapienza”, Viale Regina Elena 324, 00161, Rome, Italy

    M. Anzidei, A. Napoli, F. Zaccagna, P. Di Paolo, C. Zini, G. Cartocci, L. Di Mare, C. Catalano & R. Passariello

  2. Department of Radiology, Azienda Ospedaliera Universitaria (A.O.U.) Cagliari, Polo di Monserrato, Italy

    L. Saba & B. Cavallo Marincola

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  1. M. Anzidei
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  2. A. Napoli
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  3. F. Zaccagna
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  4. P. Di Paolo
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  5. L. Saba
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  10. C. Catalano
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Correspondence to M. Anzidei.

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Anzidei, M., Napoli, A., Zaccagna, F. et al. Diagnostic accuracy of colour Doppler ultrasonography, CT angiography and blood-pool-enhanced MR angiography in assessing carotid stenosis: a comparative study with DSA in 170 patients. Radiol med 117, 54–71 (2012). https://doi.org/10.1007/s11547-011-0651-3

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