Thomas E. Feasby, MD
In symptomatic patients, are noninvasive imaging techniques as accurate as intraarterial angiography (IAA) for diagnosing carotid stenosis?
Individual patient data meta-analysis of 9 research or audit data sets that provided blinded comparison of a noninvasive imaging technique with IAA for diagnosing carotid stenosis. 3 additional audit data sets compared results from 2 noninvasive imaging techniques (of the same or different type).
1456 patients (median age 67 y, 65% men), most of whom had symptoms of transient ischemic attack, minor stroke, amaurosis fugax, or retinal artery occlusion.
Doppler ultrasonography (DUS), computed tomographic angiography (CTA), magnetic resonance angiography (MRA), and contrast-enhanced MRA (CEMRA).
Pooled sensitivity, specificity, and positive and negative likelihood ratios of each imaging technique.
The Table shows the pooled results for diagnosing 70% to 99% carotid stenosis. CEMRA provided the most accurate results and CTA the least accurate. Evidence for the accuracy of the imaging techniques in diagnosing 50% to 69% stenosis was limited. Diagnosis of 70% to 99% stenosis in the ipsilateral artery by a first noninvasive imaging test was confirmed by a second noninvasive test in 86% of cases for DUS followed by DUS (130 patients), in 75% of cases for CEMRA followed by CEMRA (52 patients), and in 80% of cases for DUS followed by CEMRA (74 patients). In general, accuracy of noninvasive imaging was higher in contralateral arteries than in ipsilateral arteries. Test accuracy was not affected by patient age or sex.
Contrast-enhanced magnetic resonance angiography is the most accurate noninvasive imaging technique for diagnosing carotid stenosis in symptomatic patients.
Noninvasive imaging techniques compared with intraarterial angiography for diagnosing 70% to 99% carotid stenosis in symptomatic patients*
*CEMRA = contrast-enhanced magnetic resonance angiography; CTA = computed tomographic angiography; DUS = Doppler ultrasonography; MRA = magnetic resonance angiography; diagnostic terms and CI defined in Glossary. LRs calculated from sensitivity and specificity.
Feasby TE. Contrast-enhanced magnetic resonance angiography is the most accurate noninvasive imaging technique for carotid stenosis. Ann Intern Med. ;151:JC4–15. doi: 10.7326/0003-4819-151-8-200910200-02015
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Published: Ann Intern Med. 2009;151(8):JC4-15.
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