COMPLETE MR-ANGIOGRAPHY AND DOPPLER ULTRASOUND AS THE SOLE IMAGING MODALITIES PRIOR TO CAROTID ENDARTERECTOMY

Objective: To assess the combination of duplex Doppler ultrasound (DUS ) and complete carotid magnetic resonance angiography (MRA) for the no n-invasive imaging of carotid disease and their effect on outcomes. De termine inter-reader agreement of carotid MRA, Materials and Methods: One-hundred and ten carotid bifurcations were evaluated using DUS, 2D and 3D time-of-flight MRA from the aortic arch to the Circle of Willis in 55 patients, Percentage stenoses were determined by two blinded re aders using standardized criteria. Clinical follow-up was by chart rev iew. Results: Correlation of Doppler and MRA was excellent (r = 0.903, P < 0.001). Inter-reader agreement (kappa) for MRA was good: internal carotid artery (ICA) (0.750), external carotid artery (ECA) (0.674) a nd common carotid artery (CCA) (0.410). Differences in CCA readings we re due to minor differences in categorizing lesions as CCA versus ICA or EGA. MRA and Doppler detected nine occluded ICAs, Two DUS occlusion s had ICA flow by MRA; one due to a reconstituted precavernous ICA, on e a near occluded vessel. Five patients (9%) had surgical management m odified by MRA with four not having surgery: three distal ICA/Siphon o cclusions and one less severe stenosis by MRA, One tandem lesion not v isualized by DUS was surgically significant. Nine aortic arch abnormal ities had no surgical impact, possibly due to small sample size. Of 41 endarterectomies, there were no complications from errors of diagnosi s, Conclusion: Carotid MRA correlates well with DUS with good inter-re ader agreement. MRA confirms Doppler findings, expands anatomical info rmation and identifies tandem lesions from the aortic arch to the Circ le of Willis which can affect surgical management. This approach to ca rotid artery imaging appears to have no negative effect on surgical ou tcome.