Authors' objectives:

To identify the literature on MRA that is relevant to the use of MRA for presurgical assessment in carotid artery disease and in peripheral vascular disease.

- To synthesise published evidence about the diagnostic performance of MRA, compared with DSA, in carotid artery disease and in peripheral vascular disease at surgical decision thresholds.

- To use this evidence, together with other information about costs and outcomes, to model the cost-effectiveness of MRA compared with conventional angiography in carotid artery disease and in peripheral vascular disease.

Authors' results and conclusions: Ten articles on carotid artery stenosis satisfied all the inclusion criteria and a further 24 satisfied at least four inclusion criteria. There were too few articles on the latest contrast-enhanced techniques for quantitative synthesis, but the results appear better than those for 2D and 3D TOF methods. The time-of-flight (TOF) methods are highly accurate for detecting occlusion and 70-99% stenoses, but are less accurate for 50-99% stenoses. The decision analytic model showed that over 10 years following its use, magnetic resonance angiography (MRA) is expected to cost 194 GBP less than digital subtraction angiography (DSA), with no difference in expected quality-adjusted life-years (QALYs). Providing the equipment is used at more than 10% of capacity, MRA is associated with lower expected costs than DSA. Twenty articles on peripheral vascular disease satisfied all the inclusion criteria. Both 2D TOF and contrast-enhanced MRA are highly accurate for distinguishing 0-49% from 50-100% stenoses. The contrast-enhanced techniques show a non-significant trend for improved performance over 2D TOF MRA. The decision analytic model showed that there is no difference in expected QALYs for MRA and DSA. If the equipment is used at under 100% of capacity, 2D TOF MRA is associated with higher expected costs than DSA, but contrast-enhanced MRA has lower expected costs.

Authors' recommendations: In carotid artery disease, 2D and 3D TOF MRA techniques are accurate for identifying both occlusions and 7099% stenoses as defined by conventional angiography. The evidence does not support their use for identifying 5099% stenoses. If the utilisation rate for an MRA system to evaluate all patients (with and without carotid artery disease) is greater than 10%, then MRA is likely to be a cost-effective option. In peripheral vascular disease the evidence supports the use of 2D TOF and contrast-enhanced MRA techniques for identifying occlusions and 50-100% stenoses. If both DSA and MRA are already available in the local setting, then MRA is more cost-effective than DSA, especially if contrast-enhanced MRA is available. The conclusions about cost-effectiveness are valid only for high-quality diagnostic studies. Such examinations can only be performed following training and adequate experience. Consequently, there is a case for guidelines, training and accreditation schemes to be established by the relevant professional bodies.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.hta.ac.uk/1113

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

Copyright: 2009 Queen's Printer and Controller of HMSO