Karotid arter stenozlarının incelenmesinde, renkli doppler ultrasonografi ve manyetik rezonans anjiyografinin dijital substraksiyon anjiyografi ile karşılaştırılması

Abstract

Aim: To evaluate the value of color Doppler US, 2D TOF MR angiography and contrast-enhanced MR angiography by comparing with DSA for detection of carotid artery stenosis. Materials and Methods: This study includes 37 patients (74 carotid artery) with carotid artery stenosis. Doppler US and DSA examination were performed in all patients. 2D TOF MR angiography examination was performed in 32 patients and contrast-enhanced MR angiography was performed in 20 patients. Three readers independently evaluated stenosis on DSA, 2D TOF MR angiography and contrast- enhanced MR angiography. The severity of stenosis was defined based on NASCET criteria (grade 0: normal, grade 1: 0-29%, grade 2: 30-69%, grade 3: 70-99%, grade 4: 100%). Results of each modality were compared with the corresponding DSA findings and sensitivity, specificity, PPV, NPV of each modality were calculated for the detection of the high grade (70-99%) carotid artery stenosis. Results: In 37 patients, 74 carotid arteries were evaluated. Bilateral carotid artery stenosis were seen in 15 patients (40%). In 74 carotid arteries, 24 arteries (32%>) were normal, 12 arteries (16%) were grade 1 stenosis, 18 arteries (25%) were grade 2 stenosis, 12 arteries (16%) were grade 3 stenosis and 8 arteries (11%) were occluded. Doppler US had a sensitivity, specificity, PPV and NPV of 83.3%, 93.5%, 71.4%, 96.6% respectively for the idendification of high grade carotid artery stenosis. Sensitivity, specificity, PPV and NPV of contrast-enhanced MR angiography were 85.7%, 93.9%, 75%, 96.8% respectively. Sensitivity, specificity, PPV and NPV of 2D TOF MR angiography were 80%, 95.6%, 80%, 95.6% respectively. Conclusion: Doppler US, 2D TOF MR angiography and contrast-enhanced MR angiography are reliable, noninvasive tools for the detection of high grade carotid artery stenosis with high sensivity and specificity values. Key words: Carotid artery stenosis, angiography, magnetic resonance, Doppler ultrasonography vm