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Carotid Artery Stenosis: Intraindividual Correlations of 3D Time-of-Flight MR Angiography, Contrast-enhanced MR Angiography, Conventional DSA, and Rotational Angiography for Detection and Grading¹

¹ From the Departments of Neuroradiology (N.A., F.S., L.S., C.R., L.S.P., G.S.) and Vascular Surgery (R. Castellano, R. Chiesa), Scientific Institute, Ospedale San Raffaele, Milan 20132, Italy; and Worldwide Medical Affairs, Bracco Imaging, Milan, Italy (M.A.K.). Received December 17, 2003; revision requested February 24, 2004; final revision received September 1, 2004; accepted September 29. Address correspondence to N.A. (e-mail: anzalone.nicoletta{at}hsr.it).

View larger version (16K): [in a new window]   Figure 1a. Scatter plots illustrate percentages of carotid artery stenosis at (a) contrast-enhanced MR angiography (CE-MRA) versus rotational angiography, (b) 3D TOF MR angiography (3D TOF SLINKY) versus rotational angiography, (c) conventional DSA versus rotational angiography, and (d) contrast-enhanced MR angiography versus conventional DSA. Highest correlation was noted for contrast-enhanced MR angiography versus rotational angiography, whereas lowest correlation was noted for contrast-enhanced MR angiography versus conventional DSA. In a, individual measurements were evenly distributed above and below line of equality, suggesting similar estimations of stenosis on both image types. Conversely, in c, a number of individual measurements were below line of equality, suggesting underestimation of stenosis at conventional DSA compared with rotational angiography. Underestimation of stenosis at conventional DSA led to apparent overestimations of degree of stenosis at contrast-enhanced MR angiography compared with conventional DSA in d.

View larger version (17K): [in a new window]   Figure 1b. Scatter plots illustrate percentages of carotid artery stenosis at (a) contrast-enhanced MR angiography (CE-MRA) versus rotational angiography, (b) 3D TOF MR angiography (3D TOF SLINKY) versus rotational angiography, (c) conventional DSA versus rotational angiography, and (d) contrast-enhanced MR angiography versus conventional DSA. Highest correlation was noted for contrast-enhanced MR angiography versus rotational angiography, whereas lowest correlation was noted for contrast-enhanced MR angiography versus conventional DSA. In a, individual measurements were evenly distributed above and below line of equality, suggesting similar estimations of stenosis on both image types. Conversely, in c, a number of individual measurements were below line of equality, suggesting underestimation of stenosis at conventional DSA compared with rotational angiography. Underestimation of stenosis at conventional DSA led to apparent overestimations of degree of stenosis at contrast-enhanced MR angiography compared with conventional DSA in d.

View larger version (16K): [in a new window]   Figure 1c. Scatter plots illustrate percentages of carotid artery stenosis at (a) contrast-enhanced MR angiography (CE-MRA) versus rotational angiography, (b) 3D TOF MR angiography (3D TOF SLINKY) versus rotational angiography, (c) conventional DSA versus rotational angiography, and (d) contrast-enhanced MR angiography versus conventional DSA. Highest correlation was noted for contrast-enhanced MR angiography versus rotational angiography, whereas lowest correlation was noted for contrast-enhanced MR angiography versus conventional DSA. In a, individual measurements were evenly distributed above and below line of equality, suggesting similar estimations of stenosis on both image types. Conversely, in c, a number of individual measurements were below line of equality, suggesting underestimation of stenosis at conventional DSA compared with rotational angiography. Underestimation of stenosis at conventional DSA led to apparent overestimations of degree of stenosis at contrast-enhanced MR angiography compared with conventional DSA in d.

View larger version (16K): [in a new window]   Figure 1d. Scatter plots illustrate percentages of carotid artery stenosis at (a) contrast-enhanced MR angiography (CE-MRA) versus rotational angiography, (b) 3D TOF MR angiography (3D TOF SLINKY) versus rotational angiography, (c) conventional DSA versus rotational angiography, and (d) contrast-enhanced MR angiography versus conventional DSA. Highest correlation was noted for contrast-enhanced MR angiography versus rotational angiography, whereas lowest correlation was noted for contrast-enhanced MR angiography versus conventional DSA. In a, individual measurements were evenly distributed above and below line of equality, suggesting similar estimations of stenosis on both image types. Conversely, in c, a number of individual measurements were below line of equality, suggesting underestimation of stenosis at conventional DSA compared with rotational angiography. Underestimation of stenosis at conventional DSA led to apparent overestimations of degree of stenosis at contrast-enhanced MR angiography compared with conventional DSA in d.

View larger version (78K): [in a new window]   Figure 2. Images of 64-year-old woman show near occlusion of left ICA. Minimal slow residual flow (arrow), together with normal poststenotic distal ICA, is seen on rotational and conventional DSA projections. Contrast-enhanced MR angiogram (CE-MRA) reveals normal flow in distal ICA and focal intensity (arrow) at site of stenosis, which results from delayed contrast material stagnation within possible ulceration. This defect is only partially evident on conventional DSA projection (arrow) because of earlier time of acquisition. Later acquisitions demonstrate defect more clearly (not shown). On 3D TOF MR angiogram (3D SLINKY MRA), left ICA appears fully occluded.

View larger version (79K): [in a new window]   Figure 3. Images of 72-year-old man show severe stenosis (arrow) of left ICA at rotational angiography, contrast-enhanced MR angiography (CE-MRA), and 3D TOF MR angiography (3D SLINKY MRA). Stenosis was considered one grade lower at conventional DSA in two projections.

View larger version (79K): [in a new window]   Figure 4. Images of 69-year-old woman with severe stenosis (arrow) of right ICA at rotational angiography and contrast-enhanced MR angiography (CE-MRA). Stenosis was considered two grades lower both at conventional DSA in two projections and at 3D TOF MR angiography (3D SLINKY MRA).