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a Department of
Clinical Neurosciences, Bramwell Dott Building, Western General
Hospital NHS Trust, Crewe Road, Edinburgh EH4 2XU, UK, b Department of Neuroradiology, c Walton Centre for Neurology, Liverpool, UK, d Department
of Neurology, Middlesborough General Hospital, Middlesborough, UK
Correspondence to: Dr J Wardlaw jmw{at}skull.dcn.ed.ac.uk
Received 7 July 2000 and in revised form 20 November 2000;
Accepted 11 January 2001
OBJECTIVES
The
accuracy of magnetic resonance angiography (MRA) was determined in
patients with recently symptomatic tight (80%-99%) carotid stenosis
(on Doppler ultrasound), and the effect of stenosis severity on the
accuracy and interobserver variability of MRA was studied.
METHODSForty four
consecutive patients undergoing intra-arterial angiography (IAA) before
carotid endarterectomy were prospectively studied, in two centres with
identical MR scanners and sequences. All patients had undergone Doppler
ultrasound, showing a 70% or worse carotid stenosis on the symptomatic
side. MRA and IAA were done during the same admission. The MRA films
were each independently and blindly read for percentage stenosis
(signal gap if present) by four observers. The IA angiograms were read
separately by one observer, blind to symptoms, and Doppler and MRA results.
RESULTSSignal
gaps on MRA were seen in stenoses ranging from 67% to 99% on
intra-arterial angiography. Magnetic resonance angiograms consistently
overestimated the percentage stenosis according to intra-arterial
angiography. Clinically significant misclassification of stenosis
occurred according to MRA in 7% of patients, and was more frequent as
carotid stenosis increased.
CONCLUSIONSignificant
diagnostic errors occur with MRA in patients with tight carotid
stenosis. Any morbidity occurring as a result of misclassification by
MRA is likely to be offset by the avoidance of complications; however,
this could only be determined with certainty in a randomised controlled trial.
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