Open AccessMultiple reader comparison of 2D TOF, 3D TOF, and CEMRA in screening of the carotid bifurcations: Time to reconsider routine contrast use?
Author(s) -
Jeffrey S. Ross,
Skye A. Buckner Petty,
Waleed Brinjikji,
Joseph M. Hoxworth,
Vance T. Lehman,
Erik H. Middlebrooks,
Ajay Kumar Patel,
Christopher P. Wood
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0237856
Subject(s) - medicine , intraclass correlation , stenosis , contrast (vision) , radiology , population , nuclear medicine , image quality , nephrogenic systemic fibrosis , reliability (semiconductor) , magnetic resonance imaging , computer science , artificial intelligence , physics , clinical psychology , power (physics) , environmental health , quantum mechanics , image (mathematics) , psychometrics
Background and purpose MR contrast-enhanced techniques are undergoing increased scrutiny since the FDA applied a warning for gadolinium-based MR contrast agents due to gadolinium deposition within multiple organ systems. While CE-MRA provides excellent image quality, is it required in a screening carotid study? This study compares 2D TOF and 3D TOF MRA vs. CE-MRA in defining carotid stenosis in a large clinical patient population, and with multiple readers with varying experience. Materials and methods 200 consecutive patients had their carotid bifurcations evaluated with 2D TOF, 3D TOF and CE-MRA sequences by 6 board-certified neuroradiologists. Stenosis and quality of examinations were defined for each study. Inter-rater reliability was assessed using two-way random effects intraclass correlation coefficients. Intra-reader reliability was computed via weighted Cohen’s κ. Weighted Cohen’s κ were also computed to assess agreement in stenosis ratings between enhanced images and unenhanced images. Results Agreement between unenhanced and enhanced ratings was substantial with a pooled weighted κ of 0.733 (0.628–0.811). For 5 of the 6 readers, the combination of unenhanced 2D TOF and 3D TOF showed better agreement with contrast-enhanced than either 2D TOF or 3D TOF alone. Intra-reader reliability was substantial. Conclusions The combination of 2D TOF and 3D TOF MRA showed substantial agreement with CE-MRA regarding degree of carotid stenosis in this large outpatient population across multiple readers of varying experience. Given the scrutiny that GBCA are undergoing due to concerns regarding CNS and soft tissue deposition, it seems prudent to reserve CE-MRA for cases which are not satisfactorily answered by the nonenhanced study or other noninvasive examinations.