Multiple reader comparison of 2D TOF, 3D TOF, and CEMRA in screening of the carotid bifurcations: Time to reconsider routine contrast use?

<h4>Background and purpose</h4>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 requir...

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Main Authors: Jeffrey S Ross, Skye A Buckner Petty, Waleed Brinjikji, Joseph M Hoxworth, Vance T Lehman, Erik H Middlebrooks, Ameet C Patel, Christopher P Wood
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2020-01-01
Series:PLoS ONE
Online Access:https://doi.org/10.1371/journal.pone.0237856
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spelling doaj-f3217057bd9b42a790bb6c3fc1aa631e2021-03-04T11:14:01ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-01159e023785610.1371/journal.pone.0237856Multiple reader comparison of 2D TOF, 3D TOF, and CEMRA in screening of the carotid bifurcations: Time to reconsider routine contrast use?Jeffrey S RossSkye A Buckner PettyWaleed BrinjikjiJoseph M HoxworthVance T LehmanErik H MiddlebrooksAmeet C PatelChristopher P Wood<h4>Background and purpose</h4>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.<h4>Materials and methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.https://doi.org/10.1371/journal.pone.0237856
collection DOAJ
language English
format Article
sources DOAJ
author Jeffrey S Ross
Skye A Buckner Petty
Waleed Brinjikji
Joseph M Hoxworth
Vance T Lehman
Erik H Middlebrooks
Ameet C Patel
Christopher P Wood
spellingShingle Jeffrey S Ross
Skye A Buckner Petty
Waleed Brinjikji
Joseph M Hoxworth
Vance T Lehman
Erik H Middlebrooks
Ameet C Patel
Christopher P Wood
Multiple reader comparison of 2D TOF, 3D TOF, and CEMRA in screening of the carotid bifurcations: Time to reconsider routine contrast use?
PLoS ONE
author_facet Jeffrey S Ross
Skye A Buckner Petty
Waleed Brinjikji
Joseph M Hoxworth
Vance T Lehman
Erik H Middlebrooks
Ameet C Patel
Christopher P Wood
author_sort Jeffrey S Ross
title Multiple reader comparison of 2D TOF, 3D TOF, and CEMRA in screening of the carotid bifurcations: Time to reconsider routine contrast use?
title_short Multiple reader comparison of 2D TOF, 3D TOF, and CEMRA in screening of the carotid bifurcations: Time to reconsider routine contrast use?
title_full Multiple reader comparison of 2D TOF, 3D TOF, and CEMRA in screening of the carotid bifurcations: Time to reconsider routine contrast use?
title_fullStr Multiple reader comparison of 2D TOF, 3D TOF, and CEMRA in screening of the carotid bifurcations: Time to reconsider routine contrast use?
title_full_unstemmed Multiple reader comparison of 2D TOF, 3D TOF, and CEMRA in screening of the carotid bifurcations: Time to reconsider routine contrast use?
title_sort multiple reader comparison of 2d tof, 3d tof, and cemra in screening of the carotid bifurcations: time to reconsider routine contrast use?
publisher Public Library of Science (PLoS)
series PLoS ONE
issn 1932-6203
publishDate 2020-01-01
description <h4>Background and purpose</h4>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.<h4>Materials and methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.
url https://doi.org/10.1371/journal.pone.0237856
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