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Use of magnetic resonance angiography to select candidates with recently symptomatic carotid stenosis for surgery: systematic review

Kelly, S., Bamford, J.M., Airey, C.M., Meaney, J.F.M., Davies, L.M., Cullingworth, J., Westwood, M.E., Berry, E., Gough, M.J. and Smith, M.A. (2002) Use of magnetic resonance angiography to select candidates with recently symptomatic carotid stenosis for surgery: systematic review. BMJ. pp. 198-201. ISSN 1756-1833

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Objective To determine if sufficient evidence exists to support the use of magnetic resonance angiography as a means of selecting patients with recently symptomatic high grade carotid stenosis for surgery. Design Systematic review of published research on the diagnostic performance of magnetic resonance angiography, 1990-9. Main outcome measures Performance characteristics of diagnostic test. Results 126 potentially relevant articles were identified, but many articles failed to examine die performance of magnetic resonance angiography as a diagnostic test at the surgical decision thresholds used in major clinical trials on endarterectomy. 26 articles were included in a meta-analysis that showed a maximal joint sensitivity and specificity of 99% (95% confidence interval 98% to 100%) for identifying 70-99% stenosis and 90% (81% to 99%) for identifying 50-99% stenosis. Only four articles evaluated contrast enhanced magnetic resonance angiography. Conclusions Magnetic resonance angiography is accurate for selecting patients for carotid endarterectomy at the surgical decision thresholds established in the major endarterectomy trials, but the evidence is not very robust because of the heterogeneity of the studies included. Research is to determine the diagnostic performance of the most recent developments in magnetic resonance angiography, including contrast enhanced techniques, as well as to assess the impact of magnetic resonance angiography on surgical decision making and outcomes.

Item Type: Article
Copyright, Publisher and Additional Information: © BMJ 2002
Institution: The University of York
Academic Units: The University of York > Centre for Health Economics (York)
Depositing User: Elizabeth Berry
Date Deposited: 13 Mar 2006
Last Modified: 03 Apr 2016 07:20
Published Version: http://dx.doi.org/10.1136/bmj.324.7331.198
Status: Published
Refereed: Yes
URI: http://eprints.whiterose.ac.uk/id/eprint/155

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