Efficacy of screening MR angiography and Doppler ultrasonography in the evaluation of carotid artery stenosis

J. E. White, W. L. Russell, Michael Greer, M. T. Whittle

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Significant progress has been made in the development of noninvasive screening techniques for evaluation of the carotid bifurcation prior to contrast angiography. The role and significance of Magnetic Resonance Angiography (MRA) as an efficient cost effective screening examination for carotid artery stenosis remains to be determined. To that end, 120 carotid vessels, in 60 consecutive patients with carotid artery disease, were studied using MRA, Duplex ultrasonography (U/S), and conventional Digital Subtraction Arteriography (DSA). In a prospective blinded manner, using a standard scoring schematic, each carotid artery was evaluated with regard to degree of stenosis, zone of stenosis, and quality of the screening examination. The efficacy of MRA and U/S for detection of extracranial carotid stenoses was correlated with conventional DSA, which was used as a 'standard of reference' for each patient. Screening studies were considered positive if the vessel stenosis was determined to be greater than 40 per cent. As a screening examination, U/S yielded a sensitivity of 88 per cent and a specificity of 81 per cent with 11 false positive and 7 false negative studies. MRA yielded a sensitivity of 84 per cent and a specificity of 81 per cent with 11 false positive and 9 false negative studies. Range of cost of each imaging modality was surveyed from our region as well as ease of access to each modality. MRA and U/S achieved equivalent accuracy as screening examinations and correlated well in sensitivity and specificity when quality of the examination and experience of the examination center was taken into consideration. When there was an exact correlation between MRA and U/S screening exams, 100 per cent accuracy was achieved in comparison with DSA. Efficacy of a screening imaging modality must include cost effective management of health care dollars, accuracy, reliability, and ease of access. For these reasons, Duplex ultrasonography continues to offer the least expensive, most efficient, and accessible method for noninvasive evaluation of the carotid arteries prior to contrast angiography.

Original languageEnglish (US)
Pages (from-to)340-348
Number of pages9
JournalAmerican Surgeon
Volume60
Issue number5
StatePublished - 1994
Externally publishedYes

Fingerprint

Doppler Ultrasonography
Magnetic Resonance Angiography
Carotid Stenosis
Ultrasonography
Angiography
Pathologic Constriction
Carotid Arteries
Costs and Cost Analysis
Carotid Artery Diseases
Delivery of Health Care
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Efficacy of screening MR angiography and Doppler ultrasonography in the evaluation of carotid artery stenosis. / White, J. E.; Russell, W. L.; Greer, Michael; Whittle, M. T.

In: American Surgeon, Vol. 60, No. 5, 1994, p. 340-348.

Research output: Contribution to journalArticle

@article{8a3d55cbe558467caae936f5e361fe24,
title = "Efficacy of screening MR angiography and Doppler ultrasonography in the evaluation of carotid artery stenosis",
abstract = "Significant progress has been made in the development of noninvasive screening techniques for evaluation of the carotid bifurcation prior to contrast angiography. The role and significance of Magnetic Resonance Angiography (MRA) as an efficient cost effective screening examination for carotid artery stenosis remains to be determined. To that end, 120 carotid vessels, in 60 consecutive patients with carotid artery disease, were studied using MRA, Duplex ultrasonography (U/S), and conventional Digital Subtraction Arteriography (DSA). In a prospective blinded manner, using a standard scoring schematic, each carotid artery was evaluated with regard to degree of stenosis, zone of stenosis, and quality of the screening examination. The efficacy of MRA and U/S for detection of extracranial carotid stenoses was correlated with conventional DSA, which was used as a 'standard of reference' for each patient. Screening studies were considered positive if the vessel stenosis was determined to be greater than 40 per cent. As a screening examination, U/S yielded a sensitivity of 88 per cent and a specificity of 81 per cent with 11 false positive and 7 false negative studies. MRA yielded a sensitivity of 84 per cent and a specificity of 81 per cent with 11 false positive and 9 false negative studies. Range of cost of each imaging modality was surveyed from our region as well as ease of access to each modality. MRA and U/S achieved equivalent accuracy as screening examinations and correlated well in sensitivity and specificity when quality of the examination and experience of the examination center was taken into consideration. When there was an exact correlation between MRA and U/S screening exams, 100 per cent accuracy was achieved in comparison with DSA. Efficacy of a screening imaging modality must include cost effective management of health care dollars, accuracy, reliability, and ease of access. For these reasons, Duplex ultrasonography continues to offer the least expensive, most efficient, and accessible method for noninvasive evaluation of the carotid arteries prior to contrast angiography.",
author = "White, {J. E.} and Russell, {W. L.} and Michael Greer and Whittle, {M. T.}",
year = "1994",
language = "English (US)",
volume = "60",
pages = "340--348",
journal = "American Surgeon",
issn = "0003-1348",
publisher = "Southeastern Surgical Congress",
number = "5",

}

TY - JOUR

T1 - Efficacy of screening MR angiography and Doppler ultrasonography in the evaluation of carotid artery stenosis

AU - White, J. E.

AU - Russell, W. L.

AU - Greer, Michael

AU - Whittle, M. T.

PY - 1994

Y1 - 1994

N2 - Significant progress has been made in the development of noninvasive screening techniques for evaluation of the carotid bifurcation prior to contrast angiography. The role and significance of Magnetic Resonance Angiography (MRA) as an efficient cost effective screening examination for carotid artery stenosis remains to be determined. To that end, 120 carotid vessels, in 60 consecutive patients with carotid artery disease, were studied using MRA, Duplex ultrasonography (U/S), and conventional Digital Subtraction Arteriography (DSA). In a prospective blinded manner, using a standard scoring schematic, each carotid artery was evaluated with regard to degree of stenosis, zone of stenosis, and quality of the screening examination. The efficacy of MRA and U/S for detection of extracranial carotid stenoses was correlated with conventional DSA, which was used as a 'standard of reference' for each patient. Screening studies were considered positive if the vessel stenosis was determined to be greater than 40 per cent. As a screening examination, U/S yielded a sensitivity of 88 per cent and a specificity of 81 per cent with 11 false positive and 7 false negative studies. MRA yielded a sensitivity of 84 per cent and a specificity of 81 per cent with 11 false positive and 9 false negative studies. Range of cost of each imaging modality was surveyed from our region as well as ease of access to each modality. MRA and U/S achieved equivalent accuracy as screening examinations and correlated well in sensitivity and specificity when quality of the examination and experience of the examination center was taken into consideration. When there was an exact correlation between MRA and U/S screening exams, 100 per cent accuracy was achieved in comparison with DSA. Efficacy of a screening imaging modality must include cost effective management of health care dollars, accuracy, reliability, and ease of access. For these reasons, Duplex ultrasonography continues to offer the least expensive, most efficient, and accessible method for noninvasive evaluation of the carotid arteries prior to contrast angiography.

AB - Significant progress has been made in the development of noninvasive screening techniques for evaluation of the carotid bifurcation prior to contrast angiography. The role and significance of Magnetic Resonance Angiography (MRA) as an efficient cost effective screening examination for carotid artery stenosis remains to be determined. To that end, 120 carotid vessels, in 60 consecutive patients with carotid artery disease, were studied using MRA, Duplex ultrasonography (U/S), and conventional Digital Subtraction Arteriography (DSA). In a prospective blinded manner, using a standard scoring schematic, each carotid artery was evaluated with regard to degree of stenosis, zone of stenosis, and quality of the screening examination. The efficacy of MRA and U/S for detection of extracranial carotid stenoses was correlated with conventional DSA, which was used as a 'standard of reference' for each patient. Screening studies were considered positive if the vessel stenosis was determined to be greater than 40 per cent. As a screening examination, U/S yielded a sensitivity of 88 per cent and a specificity of 81 per cent with 11 false positive and 7 false negative studies. MRA yielded a sensitivity of 84 per cent and a specificity of 81 per cent with 11 false positive and 9 false negative studies. Range of cost of each imaging modality was surveyed from our region as well as ease of access to each modality. MRA and U/S achieved equivalent accuracy as screening examinations and correlated well in sensitivity and specificity when quality of the examination and experience of the examination center was taken into consideration. When there was an exact correlation between MRA and U/S screening exams, 100 per cent accuracy was achieved in comparison with DSA. Efficacy of a screening imaging modality must include cost effective management of health care dollars, accuracy, reliability, and ease of access. For these reasons, Duplex ultrasonography continues to offer the least expensive, most efficient, and accessible method for noninvasive evaluation of the carotid arteries prior to contrast angiography.

UR - http://www.scopus.com/inward/record.url?scp=0028212377&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028212377&partnerID=8YFLogxK

M3 - Article

VL - 60

SP - 340

EP - 348

JO - American Surgeon

JF - American Surgeon

SN - 0003-1348

IS - 5

ER -