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Diagnostic accuracy of contrast-enhanced MR angiography in severe carotid stenosis: meta-analysis with metaregression of different techniques.

Menke J - Eur Radiol (2009)

Bottom Line: Metaregressions found significant differences for specificity with two covariates: specificity was higher when using not only maximum intensity projection (MIP) images, but also three-dimensional (3D) images (P = 0.01).The timing technique (bolus-timed, fluoroscopically triggered or time-resolved) did not result in any significant differences in diagnostic accuracy.Some nonsignificant trends were found for the percentages of severe carotid disease, acquisition time and voxel size.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, University Hospital, Robert-Koch-Strasse 40, Goettingen 37075, Germany. Menke-J@T-Online.de

ABSTRACT
Contrast-enhanced magnetic resonance angiography (CE-MRA) has become a well-established noninvasive imaging method for the assessment of severe carotid stenosis (70-99% by NASCET criteria). However, CE-MRA is not a standardised technique, but encompasses different concurrent techniques. This review analyses possible differences. A bivariate random effects meta-analysis of 17 primary diagnostic accuracy studies confirmed a high pooled sensitivity of 94.3% and specificity of 93.0% for carotid CE-MRA in severe carotid stenosis. Sensitivity was fairly uniform among the studies, while specificity showed significant variation (I (2) = 73%). Metaregressions found significant differences for specificity with two covariates: specificity was higher when using not only maximum intensity projection (MIP) images, but also three-dimensional (3D) images (P = 0.01). Specificity was also higher with electronic images than with hardcopies (P = 0.02). The timing technique (bolus-timed, fluoroscopically triggered or time-resolved) did not result in any significant differences in diagnostic accuracy. Some nonsignificant trends were found for the percentages of severe carotid disease, acquisition time and voxel size. In conclusion, in CE-MRA of severe carotid stenosis the three major timing techniques yield comparably high diagnostic accuracy, electronic images are more specific than hardcopies, and 3D images should be used in addition to MIP images to increase the specificity.

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ROC plot of sensitivity versus specificity. The sensitivities and specificities of the 17 primary studies are represented by the small grey circles. The central black spot represents the bivariate summary estimate from the random effects meta-analysis. The surrounding confidence ellipse shows the corresponding bivariate 95% confidence interval. Here the confidence ellipse is asymmetrical, because it is shown on the original sensitivity/specificity scale instead of the linearised logit-link scale
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Fig3: ROC plot of sensitivity versus specificity. The sensitivities and specificities of the 17 primary studies are represented by the small grey circles. The central black spot represents the bivariate summary estimate from the random effects meta-analysis. The surrounding confidence ellipse shows the corresponding bivariate 95% confidence interval. Here the confidence ellipse is asymmetrical, because it is shown on the original sensitivity/specificity scale instead of the linearised logit-link scale

Mentions: The bivariate random effects meta-analysis gave the following pooled estimates (with 95% confidence intervals in parentheses): sensitivity 94.3% (92.0–96.0%), specificity 93.0% (89.8–95.3%) and LOR 5.40 (4.85–5.95). A receiver operating characteristic (ROC) plot of sensitivity versus specificity is shown in Fig. 3.Fig. 3


Diagnostic accuracy of contrast-enhanced MR angiography in severe carotid stenosis: meta-analysis with metaregression of different techniques.

Menke J - Eur Radiol (2009)

ROC plot of sensitivity versus specificity. The sensitivities and specificities of the 17 primary studies are represented by the small grey circles. The central black spot represents the bivariate summary estimate from the random effects meta-analysis. The surrounding confidence ellipse shows the corresponding bivariate 95% confidence interval. Here the confidence ellipse is asymmetrical, because it is shown on the original sensitivity/specificity scale instead of the linearised logit-link scale
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2719078&req=5

Fig3: ROC plot of sensitivity versus specificity. The sensitivities and specificities of the 17 primary studies are represented by the small grey circles. The central black spot represents the bivariate summary estimate from the random effects meta-analysis. The surrounding confidence ellipse shows the corresponding bivariate 95% confidence interval. Here the confidence ellipse is asymmetrical, because it is shown on the original sensitivity/specificity scale instead of the linearised logit-link scale
Mentions: The bivariate random effects meta-analysis gave the following pooled estimates (with 95% confidence intervals in parentheses): sensitivity 94.3% (92.0–96.0%), specificity 93.0% (89.8–95.3%) and LOR 5.40 (4.85–5.95). A receiver operating characteristic (ROC) plot of sensitivity versus specificity is shown in Fig. 3.Fig. 3

Bottom Line: Metaregressions found significant differences for specificity with two covariates: specificity was higher when using not only maximum intensity projection (MIP) images, but also three-dimensional (3D) images (P = 0.01).The timing technique (bolus-timed, fluoroscopically triggered or time-resolved) did not result in any significant differences in diagnostic accuracy.Some nonsignificant trends were found for the percentages of severe carotid disease, acquisition time and voxel size.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, University Hospital, Robert-Koch-Strasse 40, Goettingen 37075, Germany. Menke-J@T-Online.de

ABSTRACT
Contrast-enhanced magnetic resonance angiography (CE-MRA) has become a well-established noninvasive imaging method for the assessment of severe carotid stenosis (70-99% by NASCET criteria). However, CE-MRA is not a standardised technique, but encompasses different concurrent techniques. This review analyses possible differences. A bivariate random effects meta-analysis of 17 primary diagnostic accuracy studies confirmed a high pooled sensitivity of 94.3% and specificity of 93.0% for carotid CE-MRA in severe carotid stenosis. Sensitivity was fairly uniform among the studies, while specificity showed significant variation (I (2) = 73%). Metaregressions found significant differences for specificity with two covariates: specificity was higher when using not only maximum intensity projection (MIP) images, but also three-dimensional (3D) images (P = 0.01). Specificity was also higher with electronic images than with hardcopies (P = 0.02). The timing technique (bolus-timed, fluoroscopically triggered or time-resolved) did not result in any significant differences in diagnostic accuracy. Some nonsignificant trends were found for the percentages of severe carotid disease, acquisition time and voxel size. In conclusion, in CE-MRA of severe carotid stenosis the three major timing techniques yield comparably high diagnostic accuracy, electronic images are more specific than hardcopies, and 3D images should be used in addition to MIP images to increase the specificity.

Show MeSH
Related in: MedlinePlus