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Accuracy of Three-Dimensional Gadolinium-Enhanced MR Angiography in the Assessment of Extracranial Carotid Artery Disease

¹ Department of Radiology, Hopital Cardiovasculaire et Pneumologique L. Pradel, 28 rue du Doyen Lepine, 69500 Bron, France.
² Johns Hopkins University, Outpatient Center, Rm. 4250, 601 N. Caroline St., Baltimore, MD 21287-0845.
³ Department of Vascular Surgery, Hopital Edouart Herriot, 5 place d'Arsonval, 69437, Lyon Cedex 03, France.
⁴ Department of Biostatistics, CMI, Hopital Hotel Dieu, 1 place de l'Hopital, 69288, Lyon Cedex 02, France.

View larger version (8K): [in a new window]   Fig. 1. —Quality rating given by observer 1 to three-dimensional (3D) time-of-flight MR angiography (white) and 3D gadolinium-enhanced MR angiography (black) images of carotid artery stenosis.

View larger version (79K): [in a new window]   Fig. 2A. —70-year-old man after transient ischemic attack. Coronal multiple-intensity-projection (MIP) three-dimensional (3D) gadolinium-enhanced MR angiogram including aortic arch and circle of Willis depicts right internal carotid artery occlusion and high-grade stenosis of left internal carotid artery.

View larger version (61K): [in a new window]   Fig. 2B. —70-year-old man after transient ischemic attack. Targeted MIP 3D gadolinium-enhanced MR angiogram including left internal carotid artery better outlines contour of plaque and quantifies stenosis at 80%.

View larger version (63K): [in a new window]   Fig. 2C. —70-year-old man after transient ischemic attack. Targeted MIP 3D time-of-flight MR angiogram quantifies stenosis at 85% and shows signal loss behind plaque relative to flow turbulence.

View larger version (96K): [in a new window]   Fig. 2D. —70-year-old man after transient ischemic attack. Conventional angiogram shows 70% stenosis.

View larger version (46K): [in a new window]   Fig. 2E. —70-year-old man after transient ischemic attack. Photomicrograph of plaque in axial plane shows calcified plaque on bottom slice (calcium in dark), fibrotic plaque (fibrosis in white) in middle, and fibrotic plaque (fibrosis in white) confirming tight stenosis on top.

View larger version (27K): [in a new window]   Fig. 3. —Receiver operating characteristic curves for three-dimensional (3D) gadolinium MR angiography (solid line) and 3D time-of-flight MR angiography (dotted line) with conventional angiography as standard of comparison, including 63 carotid bifurcations. Areas under receiver operating characteristic curves are calculated at 0.88 (95% confidence interval, 0.78-0.95) and 0.90 (0.80-0.96), respectively, showing no significant differences between these two noninvasive techniques (p = 0.62).

View larger version (111K): [in a new window]   Fig. 4A. —56-year-old man after a stroke. Coronal multiple-intensity-projection (MIP) image of three-dimensional (3D) gadolinium-enhanced MR angiography of common carotid artery, internal carotid artery, and external carotid artery depicts stenosis of right internal carotid artery with deep ulceration (arrow).

View larger version (79K): [in a new window]   Fig. 4B. —56-year-old man after a stroke. Targeted MIP 3D gadolinium-enhanced MR angiogram of internal carotid artery quantifies stenosis at 50% and measures ulceration at more than 2 mm.

View larger version (105K): [in a new window]   Fig. 4C. —56-year-old man after a stroke. Targeted MIP 3D time-of-flight MR angiogram also quantifies stenosis at 50% but does not show any ulceration.

View larger version (104K): [in a new window]   Fig. 4D. —56-year-old man after a stroke. Conventional angiogram shows 40% stenosis and confirms deep ulcer at bottom of plaque.

View larger version (65K): [in a new window]   Fig. 5A. —68-year-old asymptomatic man. Limitations of two-view conventional angiography in quantifying an eccentric stenosis. Targeted multiple-intensity-projection three-dimensional (3D) gadolinium-enhanced MR angiogram (A) including right internal carotid artery shows stenosis of 80%, whereas conventional angiogram (B) shows stenosis of 58%.

View larger version (132K): [in a new window]   Fig. 5B. —68-year-old asymptomatic man. Limitations of two-view conventional angiography in quantifying an eccentric stenosis. Targeted multiple-intensity-projection three-dimensional (3D) gadolinium-enhanced MR angiogram (A) including right internal carotid artery shows stenosis of 80%, whereas conventional angiogram (B) shows stenosis of 58%.

View larger version (107K): [in a new window]   Fig. 5C. —68-year-old asymptomatic man. Limitations of two-view conventional angiography in quantifying an eccentric stenosis. High-resolution axial MR image of plaque shows eccentric plaque with stenosis of more than 80%.

View larger version (10K): [in a new window]   Fig. 5D. —68-year-old asymptomatic man. Limitations of two-view conventional angiography in quantifying an eccentric stenosis. Drawing shows how conventional angiography underestimates stenosis because of a less-than-optimal x-ray angle. When angles are not tangential to lumen (L) borders (1), conventional angiography underestimates plaque (2 and 3).

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