Cilt 7, Sayı 3, Sayfalar 208 - 216 2017-11-07

Time-Resolved Contrast-Enhanced Magnetic Resonance Angiography Versus Digital Subtraction Angiography in Internal Carotid Artery Stenosis
İnternal Karotid Arter Darlıklarında Time-Resolved Kontrastlı Manyetik Rezonans Anjiyografi ve Dijital Substraksiyon Anjiyografinin Karşılaştırılması

Erkan Gökçe [1]

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Objectives: In this study, digital subtraction angiography (DSA) being taken as a reference, the sensitivity, specificity, positive and negative predictive values (PPV and NPV), and diagnostic accuracy of time-resolved imaging of contrast kinetics magnetic resonance angiography (TRICKS MRA) was used in the detection of ICA stenosis in patients with stroke and cerebrovascular disease symptoms.
Materials and methods: From April 2009 to November 2010, 22 (16 male, 6 female) consecutive patients were included in this study. MRA was performed 1.5 Tesla MR. Results of TRICKS MRA, and DSA were read independently by two observers. ICA stenosis was measured according to the following North American Symptomatic Carotid Endarterectomy Trial (NASCET) method. From the MR angiographic maximum intensity projections (MIP), the percentage of ICA stenosis was assessed on sagittal projection, which coincided with the lateral of the DSA projections used.
Results: All segments throughout in 44 ICA’s compared at 56 point of stenosis in TRICKS MRA and DSA. The k statistics that reflected the interobserver variability between observers 1 and 2 were very good and similar for two tests: 0.73 for TRICKS MRA, and 0.83 for DSA. In the 70-99% carotid artery stenosis range, according to first and second independent observation, TRICKS MRA has a sensitivity of 100% and 100%; specificity of 92.3% and 94.2%; PPV of 50% and 50%, NPV of 100% and 100%, respectively, compared to digital subtraction angiography.
Conclusion: TRICKS MRA which has high rates of diagnostic accuracy on determining ICA stenoses could be considered as an alternative for invasive DSA which has higher risk of complications.

Amaç: Bu çalışmada, inme ve serebrovasküler hastalık semptomları olan hastalarda internal karotid arter darlığını saptamada, dijital substraksiyon anjiyografi (DSA) referans alınarak TRICKS MRA tekniğinin duyarlılık, özgüllük, olumlu ve olumsuz öngörü değerleri ve tanısal doğruluğu araştırılmıştır.

Materyal ve Metodlar: Bu çalışmaya, Nisan 2009-Kasım 2010 tarihleri arasında, toplam 22 (16 erkek, 6 kadın) olgu dahil edilmiştir. MRA incelemeleri, 1.5 Tesla MR görüntüleme sisteminde yapılmıştır. Her olgunun MRA ve DSA görüntüleri, birbirinden bağımsız iki radyolog tarafından değerlendirilmiştir. İCA stenoz oranı NASCET yöntemine göre sagittal plandaki MR anjiyografik maksimum yoğunluk projeksiyonları ve lateral plandaki DSA görüntüleri üzerinden saptanmıştır. 

Bulgular: Tüm segmentleri boyunca 44 İCA, TRICKS MRA ve DSA ile 56 stenoz noktasında karşılaştırıldı. Gözlemciler arası uyum k istatistiğine göre her iki yöntem için de çok iyi ve mükemmel düzeyde olup TRICKS MRA için 0.73 ve DSA için 0.83’dür. TRICKS MRA’nın %70-99 aralığında stenozu öngörmede birinci ve ikinci gözlemciye göre duyarlılığı; %100 ve %100, özgüllüğü  %92,3 ve %94,2, PPV %50 ve %50, NPV %100 ve %100 olarak saptanmıştır.

Sonuç: ICA stenozlarının saptanmasında yüksek tanısal doğruluk oranlarıyla TRICKS MRA’nın, komplikasyon riski yüksek, invaziv bir yöntem olan DSA’ya alternatif olarak kullanılabileceği düşünülmektedir.


  • 1- Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 1991;337(8756):1521-1526.
  • 2- Von Ingersleben G, Schmiedl UP, Hatsukami TS, Nelson JA, Subramaniam DS, Ferguson MS, et al. Characterization of atherosclerotic plaques at the carotid bifurcation: correlation of high resolution MR imaging with histological analysis-preliminary study. Radiographics 1997;17(6):117-1123.
  • 3- Garcia JH, Ho KL. Carotid atherosclerosis: definition, pathogenesis, and clinical significance. Neuroimag Clin North Am 1996;6(4):801-810.
  • 4- Mattos MA, Sumner DS, Bohannon WT, Parra J, McLafferty RB, Karch LA, et al. Carotid endarterectomy in women: Challenging the results from ACAS and NASCET Ann Surg. 2001;234(4):438-446.
  • 5- Korosec FR, Frayne R, Grist TM, Mistretta CA. Time-resolved contrast-enhanced 3D MR angiography. Magn Reson Med 1996;36(3):345-51. 6- Heiserman JE, Dean BL, Hodak JA, Flom RA, Bird CR, Drayer BP, et al. Neurologic complications of cerebral angiography. Am J Neuroradiol 1994;15(8):1401-1407.
  • 7- Waugh JR, Sacharias N. Arteriographic complications in the DSA era. Radiology 1992;182(1):243-246. 8- Willinsky RA, Taylor SM, TerBrugge K, Farb RI, Tomlinson G, Montanera W. Neurologic complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature. Radiology 2003;227(2):522-528.
  • 9- Brobeck BR, Forero NP, Romero JM. Practical noninvasive neurovascular imaging of the neck arteries in patients with stroke, transient ischemic attack, and suspected arterial disease that may lead to ischemia, infarction, or flow abnormalities. Semin Ultrasound CT MR 2006;27(3):177-93.
  • 10- Aydingöz U. The need for radiologists' awareness of nephrogenic systemic fibrosis. Diagn Interv Radiol. 2006;12(4):161-2.
  • 11- Remonda L, Senn P, Barth A, Arnold M, Lövblad KO, Schroth G. Contrast-enhanced 3D MR angiography of the carotid artery: comparison with conventional digital subtraction angiography. AJNR Am J Neuroradiol 2002;23(2):213-219.
  • 12- Anzalone N, Scomazzoni F, Castellano R, Strada L, Righi C, Politi LS, et al. Carotid artery stenosis: intraindividual correlations of 3D time of flight MR angiography, contrast enhanced MR angiography, conventional DSA, and rotational angiography for detection and grading. Radiology 2005;236(1):204-213.
  • 13- Yang CW, Carr JC, Futterer SF, Morasch MD, Yang BP, Shors SM, et al. Contrast enhanced MR angiography of the carotid and vertebrobasiler circulations. Am J Neuroradiology 2005;26(8):2095-2101.
  • 14- Nederkoorn P, Van der Graaf Y, Hunink M. Duplex ultrasound and magnetic resonance angiography compared with digital subtraction angiography in carotid artery stenosis: A systematic review. Stroke 2003;34(5):1324-1331.
  • 15- Randox B, Marro B, Koskas F, Chiras J, Dormont D, Marsault C. Proximal great vessels of aortic arch: Comprassion of three dimensinal gadolinium enhanced MR angiography and digital substraction angiography. Radiology 2003;229(3):697-702.
  • 16- De Marco JK, Schonfeld S, Keller I, Bernstein MA. Contrast enhanced carotid MR angiography with commercially available triggering mechanisms and elliptic centric phase encoding. AJR Am J Roentgenol 2001;176(1):221-7.
  • 17- Frayne R, Grist TM, Korosec FR, Willig DS, Swan JS, Turski PA, et al. MR angiography with three dimensional MR digital subtraction angiography. Topics Magn Res Imaging 1997;8(6):366–88.
  • 18- Korosec FR, Turski PA, Carroll TJ, Mistretta CA, Grist TM. Contrast-enhanced MR angiography of the carotid bifurcation. J Magn Reson Imaging 1999;10(3):317-25.
  • 19- Mistretta CA, Grist TM, Korosec FR, Frayne R, Peters DC, Mazaheri Y, et al. 3D time-resolved contrast enhanced MR DSA: Advantages and tradeoffs. Magn Reson Med 1998;40(4):571-81.
  • 20- U-King-Im JM, Graves MJ, Cross JJ, Higgins NJ, Wat J, Trivedi RA, et al. Internal carotid artery stenosis: accuracy of subjective visual impression for evaluation with digital subtraction angiography and contrast-enhanced MR angiography. Radiology 2007;244(1):213-222.
Konular
Dergi Bölümü Orjinal Çalışma
Yazarlar

Yazar: Erkan Gökçe
E-posta: erkangokce@mynet.com
Kurum: Gaziosmanpaşa University, School of Medicine, Department of Radiology. Tokat
Ülke: Turkey


Bibtex @araştırma makalesi { gopctd349805, journal = {Journal of Contemporary Medicine}, issn = {}, address = {Selçuk Üniversitesi}, year = {2017}, volume = {7}, pages = {208 - 216}, doi = {10.16899/gopctd.349805}, title = {Time-Resolved Contrast-Enhanced Magnetic Resonance Angiography Versus Digital Subtraction Angiography in Internal Carotid Artery Stenosis}, language = {en}, key = {cite}, author = {Gökçe, Erkan} } @araştırma makalesi { gopctd349805, journal = {Journal of Contemporary Medicine}, issn = {}, address = {Selçuk Üniversitesi}, year = {2017}, volume = {7}, pages = {208 - 216}, doi = {10.16899/gopctd.349805}, title = {İnternal Karotid Arter Darlıklarında Time-Resolved Kontrastlı Manyetik Rezonans Anjiyografi ve Dijital Substraksiyon Anjiyografinin Karşılaştırılması}, language = {tr}, key = {cite}, author = {Gökçe, Erkan} }
APA Gökçe, E . (2017). Time-Resolved Contrast-Enhanced Magnetic Resonance Angiography Versus Digital Subtraction Angiography in Internal Carotid Artery Stenosis. Journal of Contemporary Medicine, 7 (3), 208-216. DOI: 10.16899/gopctd.349805
MLA Gökçe, E . "Time-Resolved Contrast-Enhanced Magnetic Resonance Angiography Versus Digital Subtraction Angiography in Internal Carotid Artery Stenosis". Journal of Contemporary Medicine 7 (2017): 208-216 <http://dergipark.gov.tr/gopctd/issue/31840/349805>
Chicago Gökçe, E . "Time-Resolved Contrast-Enhanced Magnetic Resonance Angiography Versus Digital Subtraction Angiography in Internal Carotid Artery Stenosis". Journal of Contemporary Medicine 7 (2017): 208-216
RIS TY - JOUR T1 - İnternal Karotid Arter Darlıklarında Time-Resolved Kontrastlı Manyetik Rezonans Anjiyografi ve Dijital Substraksiyon Anjiyografinin Karşılaştırılması AU - Erkan Gökçe Y1 - 2017 PY - 2017 N1 - doi: 10.16899/gopctd.349805 DO - 10.16899/gopctd.349805 T2 - Journal of Contemporary Medicine JF - Journal JO - JOR SP - 208 EP - 216 VL - 7 IS - 3 SN - -2146-6009 M3 - doi: 10.16899/gopctd.349805 UR - http://dx.doi.org/10.16899/gopctd.349805 Y2 - 2017 ER -
EndNote %0 Journal of Contemporary Medicine İnternal Karotid Arter Darlıklarında Time-Resolved Kontrastlı Manyetik Rezonans Anjiyografi ve Dijital Substraksiyon Anjiyografinin Karşılaştırılması %A Erkan Gökçe %T İnternal Karotid Arter Darlıklarında Time-Resolved Kontrastlı Manyetik Rezonans Anjiyografi ve Dijital Substraksiyon Anjiyografinin Karşılaştırılması %D 2017 %J Journal of Contemporary Medicine %P -2146-6009 %V 7 %N 3 %R doi: 10.16899/gopctd.349805 %U 10.16899/gopctd.349805