scholarly journals The Reliability of Ultrasound Measurements of Carotid Stenosis Compared to MRA and DSA

2005 ◽  
Vol 32 (4) ◽  
pp. 465-471 ◽  
Author(s):  
Colin Honish ◽  
Venkatraman Sadanand ◽  
Derek Fladeland ◽  
Vance Chow ◽  
Fahrad Pirouzmand
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Carotid Stenosis ◽  
Predictive Value ◽  
Velocity Ratio ◽  
Peak Systolic Velocity ◽  
Roc Curves ◽  
Weighted Kappa ◽  
Internal Carotid Artery Stenosis ◽  
Diastolic Velocity

ABSTRACT:Objective:Carotid ultrasound (US) is a screening test for patients with transient ischemic attacks (TIAs) or stroke who then undergo Digital Subtraction Angiogram (DSA) or Magnetic Resonance Angiography (MRA). Gold standard DSA is invasive with inherent risks and costs. MRA is an evolving technology. This study compares reliability of MRA and US modes with DSA in determining degree of internal carotid artery stenosis.Methods:A five year retrospective analysis of 140 carotid arteries from patients who had carotid US and DSA, and possibly Magnetic Resonance Angiography was undertaken. Recorded US parameters were peak systolic velocity (PSV), end diastolic velocity (EDV), and ICA/CCA peak systolic velocity ratio. The MRA and DSA parameters used NASCET technique for measuring stenosis. Statistical analysis included ROC curves and Kappa computation.Results:US grading of carotid stenosis can be made more reliable by choosing appropriate parameters. The best combination of sensitivity and specificity for stenosis > 70% in our hospital was seen at PSV > 173cm/s (sensitivity 0.87, specificity 0.8, Positive Predictive Value (PPV) 0.70, Negative Predictive Value (NPV) 0.93, kappa 0.64 and weighted kappa 0.71). MRA kappa was 0.78, (sensitivity 0.75, specificity 1.0, PPV 1.0, NPV 0.85).Conclusions:US parameters should be validated in each centre. At best, US can only approximate the accuracy of DSA, probably due to inherent limitations of this modality. Magnetic Resonance Angiography has a perfect specificity and PPV but this technique needs to be standardized. Simultaneous use of MRA and US for screening increases sensitivity to over 0.9 without compromising specificity in > 70% stenosis.

scholarly journals Balanced Steady-State Free Precision and Time of Flight Noncontrast Magnetic Resonance Angiography in Peripheral Arterial Disease

2021 ◽  
Author(s):  
Soumya Susan Regi ◽  
Aparna Irodi ◽  
Shyamkumar N. Keshava ◽  
Sunil Agarwal
Keyword(s):  
Steady State ◽  
Magnetic Resonance ◽  
Image Quality ◽  
Magnetic Resonance Angiography ◽  
Peripheral Arterial Disease ◽  
Predictive Value ◽  
Weighted Kappa ◽  
Arterial Disease ◽  
Peripheral Arterial

Abstract Purpose To determine the diagnostic efficacy of balanced steady-state free precession (bSSFP) and time-of-flight (TOF)-based noncontrast magnetic resonance angiography (NC-MRA) in lower limb peripheral arterial disease (PAD). Material and Methods 10 patients with suspected PAD underwent both NC-MRA (bSSFP and 2D TOF) and contrast-enhanced MR angiography (CE-MRA)/CT angiography (CTA). A total of 170 arterial segments (17 segments in each patient) were analyzed on NC-MRA and compared with CE-MRA/CTA for quality of images and for estimating the degree of stenoses. Image quality was graded as 1—poor, 2—fair, 3—good, and 4—excellent. The degree of stenoses was graded as 0—normal, 1— ≤ 50% narrowing, 2— > 50% narrowing, 3—near complete/100% occlusion. Sensitivity, specificity, positive predictive value, and negative predictive value of NC-MRA in identifying significant stenosis, as compared with CE-MRA/CTA, were estimated. Results a) Mean grade of the image quality of NC-MRA was 3.10 and the CE-MRA/CTA was 3.64. b) The agreement in the estimation of the degree of stenosis on NC-MRA as compared with CE-MRA/CTA was substantial in aortoiliac segments (weighted kappa 0.646 [95% CI] [0.361–0.931] [p < 0.001]), almost perfect in femoropopliteal segments (weighted kappa 0.911 [95% CI] [0.79–1.032] [p < 0.001]), and poor in infrapopliteal segments (weighted kappa 0.052 [95% CI] [0.189–0.293] [p < 0.33587]). Conclusion TOF and bSSFP-based NC-MRA was found to be comparable to the CE-MRA/CTA in the evaluation of PAD in lower limbs in the aortoiliac and femoropopliteal regions. NC-MRA was especially helpful in assessing the aortoiliac vessels and femoropopliteal vessels, with the imaging of infrapopliteal arteries being suboptimal.

Duplex Sonography versus Angiography for Assessment of Femoropopliteal Arterial Disease in a “Real-World” Setting

2007 ◽  
Vol 14 (4) ◽  
pp. 452-459 ◽  
Author(s):  
Oliver Schlager ◽  
Marcel Francesconi ◽  
Markus Haumer ◽  
Petra Dick ◽  
Schila Sabeti ◽  
...  
Keyword(s):  
Real World ◽  
Predictive Value ◽  
Velocity Ratio ◽  
Peak Systolic Velocity ◽  
Duplex Ultrasound ◽  
Weighted Kappa ◽  
Arterial Disease ◽  
Duplex Sonography ◽  
Kappa Statistics ◽  
Sensitivity Specificity

Purpose: To evaluate the agreement of duplex ultrasound (DUS) versus digital subtraction angiography (DSA) for assessment of femoropopliteal arterial disease in a real-world clinical setting. Methods: Consecutive patients with peripheral artery disease who were scheduled for a percutaneous intervention were included in this retrospective study. During an 18-month period, 491 patients (276 men; median age 73 years, interquartile range 64–81) were enrolled. A peak systolic velocity ratio (PSVR) >2.4 was the optimal cutoff for detecting a >50% stenosis by DSA. Findings of preprocedural DUS in the proximal, middle, and distal ipsilateral superficial femoral artery and in the popliteal segment were analyzed for agreement with preprocedural femoropopliteal DSA using kappa statistics. Only the target limb in each patient was analyzed, for a total of 1964 vascular segments. Results: Agreement for the degree of stenosis in 10% increments was only moderate (weighted kappa 0.67, 95% CI 0.65 to 0.69). Using the PSVR >2.4 cutoff, agreement between DUS and DSA for a >50% stenosis was good (kappa 0.79, 95% CI 0.77 to 0.81). Sensitivity, specificity, positive predictive value, and negative predictive value for correctly detecting a >50% stenosis by DUS were 0.81 (0.78 to 0.84), 0.93 (0.91 to 0.94), 0.84 (0.81 to 0.87), and 0.91 (0.87 to 0.95), respectively. Comparable findings were observed within different patient subgroups. Conclusion: Agreement between DUS and DSA in the femoropopliteal segment is only moderate with respect to the absolute degree of stenosis. However, detection of a >50% stenosis can be done with acceptable precision in routine clinical practice using PSVR >2.4 as a threshold.

Combined use of duplex imaging and magnetic resonance angiography for evaluation of patients with symptomatic ipsilateral high-grade carotid stenosis

1993 ◽  
Vol 17 (5) ◽  
pp. 832-840 ◽  
Author(s):  
David S. Sumner ◽  
William D. Turnipseed ◽  
Todd W. Kennell ◽  
Patrick A. Turski ◽  
Charles W. Acher
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Carotid Stenosis ◽  
High Grade ◽  
Duplex Imaging ◽  
Combined Use

scholarly journals Measuring Carotid Stenosis on Contrast-Enhanced Magnetic Resonance Angiography

Stroke ◽  
2004 ◽  
Vol 35 (9) ◽  
pp. 2083-2088 ◽  
Author(s):  
Jean Marie K.S. U-King-Im ◽  
Rikin A. Trivedi ◽  
Justin J. Cross ◽  
Nicholas J.P. Higgins ◽  
William Hollingworth ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Carotid Stenosis ◽  
Contrast Enhanced

scholarly journals Automated quantitative assessment of cardiovascular magnetic resonance-derived atrioventricular junction velocities

2015 ◽  
Vol 309 (11) ◽  
pp. H1923-H1935 ◽  
Author(s):  
Shuang Leng ◽  
Xiao-Dan Zhao ◽  
Fei-Qiong Huang ◽  
Jia-Ing Wong ◽  
Bo-Yang Su ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Quantitative Assessment ◽  
Human Subjects ◽  
Intraclass Correlation ◽  
Peak Systolic Velocity ◽  
Left Ventricular ◽  
Diastolic Filling ◽  
Atrioventricular Junction ◽  
Diastolic Velocity

The assessment of atrioventricular junction (AVJ) deformation plays an important role in evaluating left ventricular systolic and diastolic function in clinical practice. This study aims to demonstrate the effectiveness and consistency of cardiovascular magnetic resonance (CMR) for quantitative assessment of AVJ velocity compared with tissue Doppler echocardiography (TDE). A group of 145 human subjects comprising 21 healthy volunteers, 8 patients with heart failure, 17 patients with hypertrophic cardiomyopathy, 52 patients with myocardial infarction, and 47 patients with repaired Tetralogy of Fallot were prospectively enrolled and underwent TDE and CMR scan. Six AVJ points were tracked with three CMR views. The peak systolic velocity (Sm1), diastolic velocity during early diastolic filling (Em), and late diastolic velocity during atrial contraction (Am) were extracted and analyzed. All CMR-derived septal and lateral AVJ velocities correlated well with TDE measurements (Sm1: r = 0.736; Em: r = 0.835; Am: r = 0.701; Em/Am: r = 0.691; all p < 0.001) and demonstrated excellent reproducibility [intrastudy: r = 0.921–0.991, intraclass correlation coefficient (ICC): 0.918–0.991; interstudy: r = 0.900–0.970, ICC: 0.887–0.957; all p < 0.001]. The evaluation of three-dimensional AVJ motion incorporating measurements from all views better differentiated normal and diseased states [area under the curve (AUC) = 0.918] and provided further insights into mechanical dyssynchrony diagnosis in HF patients (AUC = 0.987). These findings suggest that the CMR-based method is feasible, accurate, and consistent in quantifying the AVJ deformation, and subsequently in diagnosing systolic and diastolic cardiac dysfunction.

scholarly journals The implications of magnetic resonance angiography artifacts caused by different types of intracranial flow diverters

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Batur Halitcan ◽  
Sayin Bige ◽  
Balci Sinan ◽  
Akmangit Ilkay ◽  
Daglioglu Ergun ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Predictive Value ◽  
Diagnostic Yield ◽  
Flow Diverter ◽  
Parent Artery ◽  
Perfect Agreement ◽  
Tof Mra ◽  
Flow Diverters

Abstract Background Serial cerebral angiographic imaging is necessary to ensure cerebral aneurysm occlusion after flow diverter placement. Time-of-flight (TOF)-magnetic resonance angiography (MRA) is used for this purpose due to its lack of radiation, contrast media and complications. The comparative diagnostic yield of TOF-MRA for different flow diverters has not been previously analyzed. Purpose To evaluate the diagnostic accuracy of TOF-MRA in cerebral aneurysms treated w divertersith different flow diverters. Materials and Methods Flow-diverted patients whose cerebral follow-up MRA and digital subtraction angiograms (DSA) were obtained within 6 weeks were retrospectively identified. The DSA (as gold standard) and MRA images of these patients were compared by two readers (blinded to both patient data and endovascular procedure data) for residual aneurysms and the status of the parent artery for each type of flow diverter. In a second group of patients, magnetic susceptibility artifacts were manually measured and compared for different FDs. Results Seventy-six patients (85 aneurysms) were included in group one, and 86 patients (95 aneurysms) were included in group 2. TOF-MRA and DSA showed almost perfect agreement for residual aneurysms (κ = 0.88, p < 0.001) (positive predictive value (PPV) = 1.00, specificity = 1.00, negative predictive value (NPV) = 0.89, sensitivity = 0.89). Intermodality agreement (κ = 0.97 vs. κ = 0.74, p < 0.005) and sensitivity (0.97 vs. 0.77, NPV: 0.96 vs. 0.77) were highest with nitinol stents. MRA and DSA showed no agreement for occluded or stenotic parent vessels (κ = 0.13, p = 0.015, specificity = 0.44, NPV = 1.00, sensitivity = 1.00). Specificity was lower in chromium-cobalt based FDs than in nitinol devices (specificity = 0.08 vs. 0.60). Chromium-cobalt stents generated the largest artifacts (p < 0.005). The size of the device-related artifact, in millimeters, increased in respective order, for the Silk, Derivo, Pipeline and Surpass devices. Conclusion Unlike DSA, TOF-MRA is susceptible to dissimilarities between flow diverters. MRA is not well-suited for research studies comparing different flow diverters. Nitinol FDs appear to be advantageous for TOF-MRA follow-up so as not to miss small aneurysm remnants or clinically relevant parent artery stenosis.

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