Overestimation of moderate carotid stenosis assessed by both Doppler US and contrast enhanced 3D-MR angiography in the CARMEDAS study.

Michel Nonent 1, 2 D. Ben Salem 2, * J.-M. Serfaty 3 V. Buthion 4 A. Pasco-Papon 5 C. Rotaru 6 Luc Bressollette 1, 7 X. Papon 8 C. Pachai 9 J.-O. Fortrat 10 P. Gouny 11 Ali Badra 11 J. Berge 12 Y. Le Bras 13 J.-P. Cottier 14 J. Y. Gauvrit 15 P. Douek 16
Abstract : PURPOSE: To evaluate the agreement and diagnostic accuracy of Contrast enhanced magnetic resonance angiography (CE-MRA), Doppler ultrasound (DUS) and Digital subtraction angiography (DSA) in the assessment of carotid stenosis. METHODS: DUS, CE-MRA and DSA were performed in 56 patients included in the Carotide-angiographie par résonance magnétique-échographie-doppler-angioscanner (CARMEDAS) multicenter study with a carotid stenosis ≥ 50%. Three readers evaluated stenoses on CE-MRA and DSA (NASCET criteria). Velocities criteria were used for stenosis estimation on DUS. RESULTS: CE-MRA had a sensitivity and specificity of 96-98% and 66-83% respectively for carotid stenoses ≥ 50% and a sensitivity and specificity of 94% and 76-84% respectively for carotid stenoses ≥ 70%. The interobserver agreement of CE-MRA was excellent, except for moderate stenoses (50-69%). DUS had a sensitivity and specificity of 88 and 75% respectively for carotid stenoses ≥ 50% and a sensitivity and specificity of 83 and 86% respectively for carotid stenoses ≥ 70%. Combined concordant CE-MRA and DUS had a sensitivity and specificity of 100 and 85-90% respectively for carotid stenoses ≥ 50% and a sensitivity and specificity of 96-100% and 80-87% respectively for carotid stenoses ≥ 70%. The positive predictive value of the association CE-MRA and DUS for carotid stenoses ≥ 70% is calculated between 77 and 82% while the negative predictive value is calculated between 97 and 100%. CE-MRA and DUS have concordant findings in 63-72%, and the overestimations cases were recorded only for carotid stenosis ≤ 69%. CONCLUSION: Combined DUS-CE-MRA is excellent for evaluation of severe stenosis but remains debatable in moderate stenosis (50-69%) due to the risk of overestimations.
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Journal de Neuroradiologie / Journal of Neuroradiology, Elsevier Masson, 2011, 38 (3), pp.148-55. 〈10.1016/j.neurad.2010.05.002〉
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Soumis le : vendredi 27 juillet 2012 - 15:44:59
Dernière modification le : vendredi 22 juin 2018 - 16:34:28

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Michel Nonent, D. Ben Salem, J.-M. Serfaty, V. Buthion, A. Pasco-Papon, et al.. Overestimation of moderate carotid stenosis assessed by both Doppler US and contrast enhanced 3D-MR angiography in the CARMEDAS study.. Journal de Neuroradiologie / Journal of Neuroradiology, Elsevier Masson, 2011, 38 (3), pp.148-55. 〈10.1016/j.neurad.2010.05.002〉. 〈hal-00721482〉

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