Klinik Olarak Anlamlı Karotis Arter Stenozlarının Değerlendirilmesinde Renkli Doppler Görüntüleme, Manyetik Rezonans Anjiyografi ve Dijital Subtraksiyon Anjiyografi Yöntemlerinin Karşılaştırılması

Abstract

Aim: In this study, we aimed to compare the color Doppler ultrasonography (CDUS) and three-dimensional contrastenhanced magnetic resonance angiography (MRA) with digital subtraction angiography (DSA) which is the reference method in diagnosis of carotid artery stenosis and to compare the diagnostic efficiency of these two noninvasive methods. Materials and Methods: The study encompassed 20 (15 males and 5 females) consecutive patients with a mean age of 55.85, who were admitted to Radiology Department with the symptoms of carotid artery stenosis. In each patient, 6 arterial segments were examined separately (left and right common, external and internal carotid arteries). While RDUS was conducted in all patients, 18 patients underwent DSA, and 16 patients underwent MRA. In 14 patients, all three methods were performed. According to stenosis levels, patients were divided into 5 groups which were 0-39%, 40-59%, 60-79%, 80-99% and total occlusion. Additionally, patients were categorized into two groups according to critical stenosis value of 70% (70% and above, and below 70%). DSA was considered as the gold standard method. McNemar, kappa, and Spearman’s statistical tests were employed to calculate the sensitivity and specificity of CDUS and MRA, and correlation of those with DSA. Results: In different stenosis levels, the sensitivity and specificity of RDUS were 100% and 95.3-99.1% where, the sensitivity and specificity of MRA were 100% and 98.6-100% respectively. For occolusion the sensitivy and specificity for RDUS were 100% and 99.1 and the sensitivy and specificity of MRA were 100% and 100% respectively. There was a perfect correlation (for RDUS 􀈛=0.86-0.92, for MRA 􀁎=0.95-1) and significant positive correlation (for RDUS r=0.92, for MRA r=1). between DSA and other to methods. Repording the critical stenosis value of 70%, the sensitivity of RDUS were 100% and 94,8. Also there was a high correlation (􀁎=0.80) between RDUS and DSA, the sensitivity and spesifity of MRA were 100% and %97.3 respectively in diagrosing clinically significart stenosis (70% and above), and also kappa corelation with DSA was prerfeet (􀁎=0.89). Conclusion: The noninvasive methods of RDUS and MRA, with their high sensitivity and specificity values and lack of risks related to ionizing radiation and aterial catheterization, can be used effectively in detecting and grading the carotid artery stenosis as an alternative to DSA

Keywords

• Carotid Stenosis
• Doppler Ultrasonography
• MR Angiography
• Catheter Angiography

Comparison of Color Doppler Ultrasound Imaging and Magnetic Resonance Angiography with Digital Subtraction Angiography in Clinically Significant Carotid Artery Stenosis

Abstract

Amaç: Bu çal􀃖􀄹mada renkli Doppler ultrasonografi (RDUS) ve kontrastl􀃖 3 boyutlu manyetik rezonans anjiyografinin (MRA) karotis arter stenozu tan􀃖s􀃖nda referans inceleme yöntemi olan dijtal subtraksiyon anjiyografisi (DSA) ile kar􀄹􀃖la􀄹t􀃖r􀃖lmas􀃖 ve tan􀃖sal etkinliklerinin ara􀄹t􀃖r􀃖lmas􀃖 amaçland􀃖. Gereç-Yöntem: Klinik ve laboratuar bulgular􀃖 ile karotis arter stenozu ön tan􀃖s􀃖 olan, ya􀄹lar􀃖 33-80 aras􀃖nda de􀃾i􀄹en (ortalama 55.85), 15’i erkek, 5’i kad􀃖n toplam 20 olgu çal􀃖􀄹maya dahil edildi. Her olguda ana, eksternal ve internal karotis arterler olmak üzere 6 arter segmenti incelendi. Olgular􀃖n tümüne RDUS, 18 olguya DSA ve 16 olguya MRA yap􀃖ld􀃖. Ondört olguda ise her üç inceleme de gerçekle􀄹tirildi. Stenoz derecelerine göre olgular %0-39, %40-59, %60- 79, %80-99 ve oklüzyon olmak üzere 5 gruba ayr􀃖ld􀃖. Ayr􀃖ca NASCET’e göre kritik stenoz de􀃾eri olan %70’e göre olgular, %70 ve üzeri ile %70’in alt􀃖 olmak üzere 2 gruba ayr􀃖ld􀃖. RDUS ve MRA sonuçlar􀃖 alt􀃖n standart yöntem olan DSA sonuçlar􀃖 kar􀄹􀃖la􀄹t􀃖r􀃖larak her iki incelemenin karotis arter stenozunu saptamadaki duyarl􀃖l􀃖k, özgüllük ve uyumlar􀃖 McNemar, kappa ve Spearman’s korelasyon testleri ile belirlendi. Bulgular: Çe􀄹itli stenoz derecelerinde RDUS’nin duyarl􀃖l􀃖􀃾􀃖 %100, özgüllü􀃾ü %95.3-99.1, MRA’n􀃖n duyarl􀃖l􀃖􀃾􀃖 %100, özgüllü􀃾ü ise %98.6-100; oklüzyonda ise RDUS’nin duyarl􀃖l􀃖􀃾􀃖 %100, özgüllü􀃾ü %99.1, MRA’n􀃖n duyarl􀃖l􀃖􀃾􀃖 % 100, özgüllü􀃾ü % 100 olarak saptand􀃖. Her iki inceleme ile DSA aras􀃖nda mükemmel uyum (RDUS için 􀈛=0.86-0.92, MRA için 􀈛=0.95-1) ve kuvvetli pozitif korelasyon (RDUS için r=0.92, MRA için r=1) saptand􀃖. Kritik stenoz de􀃾eri olan %70 ve üzerine göre yap􀃖lan s􀃖n􀃖fland􀃖rmaya göre RDUS’nin duyarl􀃖l􀃖􀃾􀃖 %100, özgüllü􀃾ü %94.8 olarak bulundu. Ayr􀃖ca RDUS ile DSA aras􀃖nda yüksek uyum saptand􀃖 (􀁎=0.80). MRA’n􀃖n ise duyarl􀃖l􀃖􀃾􀃖 %100, özgüllü􀃾ü ise %97.3 olarak bulunurken DSA ile aras􀃖ndaki uyum derecesi mükemmel olarak saptand􀃖 (􀁎=0.89). Sonuç: Noninvazif, iyonize radyasyon ve arteryel kateterizasyona ba􀃾l􀃖 riskler ta􀄹􀃖mayan RDUS ve MRA, karotis arter stenozu 􀄹üphesi olan olgularda, yüksek duyarl􀃖l􀃖k ve özgüllük de􀃾erleri ile DSA’ya alternatif olarak güvenle kullan􀃖labilir.

Keywords

• Karotis Stenozu
• Doppler Ultrasonografi
• MR Anjiyografi
• Kateter Anjiyografi

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