Discordant findings in color-coded duplex-sonography and magnetic resonance angiography in symptomatic internal carotid artery stenosis: implications for diagnostic work-up and early intervention.

Background: Magnetic resonance angiography (MRA) is supposed to be the new 'gold standard' in the diagnosis of atherosclerotic disease of the extracranial arteries.
Methods: A case report is presented on a patient in whom discordant findings of the status of the left internal carotid artery (ICA) were identified in color-coded duplex-sonography and MRA.
Results: Left ICA stenosis was suspected in duplex-sonography, yet not confirmed in contrast-enhanced (CE) MRA reconstruction. Diagnosis was confirmed after surgery and in subsequent analysis of the original CE-MRI data.
Conclusions: The analysis of source images must not be missed in MRA examinations. Conventional duplex-sonography may be superior in the estimation of the embolic potential of vascular lesions. Advanced CE techniques may therefore be adequate tools in differentiating patients eligible for carotid endarterectomy (CEA) or carotid stenting, avoiding the risk of peri-interventional iatrogenic complications. It should urgently be further improved and validated.