Biomedical subjects

J R Thompson

Publications and source records attributed to J R Thompson.

At least 109 records · Page 6Linked to original sources

PubMed1997

Mortality and fatal pulmonary embolism after primary total hip replacement. Results from a regional hip register.

We calculated the rates for perioperative mortality and fatal pulmonary embolism (PE) after primary total hip replacement in a single UK health region, using a regional arthroplasty register and the tracing service of the Office of National Statistics. During 1990, there were 2111 consecutive primary replacements in 2090 separate procedures. Within 42 days of operation a total of 19 patients had died (0.91%, 95% CI 0.55 to 1.42). Postmortem examination showed that four deaths (0.19%, 95% CI 0.05 to 0.49) were definitely due to PE. The overall perioperative mortality and fatal PE rates are low and in our study did not appear to be altered by the use of chemical thromboprophylaxis (perioperative mortality rate: one-tailed Fisher's exact test, p = 0.39; fatal PE rate: one-tailed Fisher's exact test, p = 0.56). The routine use of chemical thromboprophylaxis for primary THR is still controversial. The issue should be addressed by an appropriate randomised, prospective study using overall mortality and fatal PE rate as the main outcome measures, but the feasibility of such a study is questioned.

Adult↗

PubMed1997

LOCS III versus the Oxford Clinical Cataract Classification and Grading System for the assessment of nuclear, cortical and posterior subcapsular cataract.

PURPOSE: To compare two methods of cataract grading for nuclear cataract, cortical cataract and posterior subcapsular cataract. METHODS: The Melton Eye Study is an English community-based epidemiological study of the natural history of eye disease in people aged 55 to 74 years. The lenses of both eyes of 560 subjects were graded at the slit lamp using two cataract grading systems. The Oxford Clinical Cataract Classification and Grading System (OCCCGS) employs standard diagrams and Munsell colour samples for the grading of cortical, posterior subcapsular and nuclear cataract. The Lens Opacities Classification System III (LOCS III) uses photographic transparencies of the lens as standards. In both systems a decimalised score is assigned. We also graded the LOCS III standard images using the OCCCGS. Interobserver variation was calculated for both grading systems. Linear calibration lines are plotted for each type of lens opacity. RESULTS: The relationship between LOCS III and OCCCGS for nuclear cataract and posterior subcapsular cataract is linear. The relationship for cortical cataract is linear once the LOCS III scores are squared. The intervals between the LOCS III images when ranked by the human eye using the OCCCGS are linear. Interobserver variation for both systems is good. CONCLUSIONS: The linear calibration lines may be used to convert from one system to another and will be useful in comparing studies or performing meta-analysis. These results show that data from cataract studies using different clinical grading schemes can be compared.

Aged↗

PubMed1997

Prevalence of lenticular abnormalities in a population-based study: Oxford Clinical Cataract Grading in the Melton Eye Study.

PURPOSE: To describe the distribution of the 11 features assessed by the Oxford Clinical Cataract Classification and Grading System (OCCCGS) in a population-based study. METHODS: The Melton Eye Study is an English community-based epidemiological study of the natural history of eye disease in people aged 55 to 74 years. Both lenses of 560 subjects were graded at the slit lamp using a decimalised version of the OCCCGS. Subject prevalences were estimated by logistic regression and the extent, when present, against normal errors regression. RESULTS: White nuclear scatter (WNS), brunescence, cortical spoke (CS), anterior subcapsular opacity (ASC), fibre folds (FF), waterclefts (WC) and perinuclear retro-dots all increased with age (p < 0.05). Posterior subcapsular opacity (PSC), vacuoles, focal dots (FD) and coronary flakes (CF) did not significantly increase with age. Subject prevalences of the features and the mean Oxford scores when present were: WNS (1.33), brunescence (0.88), CS 36% (0.34), PSC 11% (0.52), ASC 2% (0.53), FF 18% (0.53), WC 17% (0.29), retro-dots 11% (1.15), vacuoles 59% (0.43), FD 98% (1.79) and CF 39% (1.24). Significantly more common in women were both coronary flakes (p < 0.001) and waterclefts (p < 0.05). CONCLUSIONS: These are the first data on the distribution of these minor lesions in a population-based study. Coronary flakes and waterclefts are more common in women.

Aged↗

PubMed1997

Associations between lens features assessed in the Oxford Clinical Cataract Classification and Grading System.

PURPOSE: To study the associations between eleven lens features graded according to the Oxford Clinical Cataract Classification and Grading System (OCCCGS). METHOD: 560 subjects taking part in the Melton Eye Study had their lenses graded according to the OCCCGS by one of two examiners. Associations between features were examined using log-linear models for categorised grades. Adjustment was made for age, sex and grader. RESULTS: Within subjects, the two nuclear features, white nuclear scatter and brunescence, are closely related with one another, as are coronary flakes and focal-dots, but these two groupings are negatively associated. Cortical spoke, fibrefolds and waterclefts are all associated with one another and this group is positively associated with coronary flakes and focal-dots. Posterior subcapsular and anterior subcapsular opacity are associated with one another and with cortical spokes. A within-eye analysis gives similar results. CONCLUSION: These associations may be important in defining cataract subtypes and in identifying minor features that indicate early cataract development.

Aged↗

PubMed1997

The cross-sectional size and shape of human terminal scalp hair.

Change in size of the hair shaft with distance form the scalp has been investigated, using a rotatory profile method of diameter measurement, in terminal human scalp hair of long-haired young Caucasian women. As the whole length of hairs having completed anagen are rarely found intact, two types of hair were investigated: those including segments produced at the onset of anagen ('anagen hairs'), and those including segments produced at the end of anagen ('telogen hairs'). In addition, a method of determining the cause of any size variation has been described and employed. Changes were found in the major axis of the hair cross-section, cross-sectional area and ellipticity with distance from the scalp, while the minor cross-sectional axis remained constant. It was established that these changes were the result of intrafollicular rather than extrafollicular mechanisms. Finally, a composite picture of the cross-sectional size and shape of the 'average' whole anagen hair of the study has been constructed. From the distal tip towards the scalp for approximately 6-8 cm, there was an abrupt increase in size, representing a starting-up phase of early anagen. Following this, the hair was at its greatest cross-sectional size and ellipticity which then progressively decreased through anagen (20% decrease for cross-sectional area and 13% for ellipticity). In contrast, the minor axis of the hair cross-section, remained constant throughout anagen. The hair was not therefore a uniformly sized cylinder. It was approximately spear-shaped, being broadened out in one plane distally where it was more elliptical. Subsequently as anagen progressed the hair shaft became smaller and more circular.

Female↗

PubMed1997

Influence of yolk on blood metabolites in perinatal and neonatal chickens.

Two experiments were conducted to assess the role of the yolk sac during the perinatal period (i.e., from embryonic Day 18 through hatch) and until 15 days after hatching. Experiment 1 describes changes in several yolk components. Approximately 70% of the yolk was absorbed during the perinatal period. Moisture, lipid, protein, and carbohydrate fractions were all utilized during this period. In Experiment 2, the age at which set-point physiological levels of several blood metabolites, as well as the magnitudes of these levels, in deutectomized (DT) chicks (surgical ablation of the yolk sac within 1 hr post-hatch) were not different from non-DT controls. Results indicate that the yolk sac plays a central role in the hatching process of chicks, rather than serving as a major metabolic reserve during the neonatal period.

Animals↗

PubMed1996

Apolipoprotein E polymorphism does not predict risk of restenosis after coronary angioplasty.

A recent report has suggested that the E4 allele of apolipoprotein (apo) E increases the risk of restenosis after percutaneous transluminal coronary angioplasty (PTCA) and also that it interacts synergistically with the deletion (D) allele of the angiotensin-converting enzyme (ACE) to increase the risk sixteen-fold. To investigate this further, we genotyped 231 subjects with successful PTCA who underwent planned repeat angiography at 4 months to assess the degree of restenosis. Subjects carrying the apo E4 allele (n = 71) were well matched with non-carriers (n = 160) for clinical and pre- and post-PTCA angiographic features. We found no increase in either apo E4 allele frequency (18.4% versus 15.6%, P = 0.42) or apo E4 homozygosity (2/106 versus 5/125, P = 0.30) in those with restenosis compared with those without. The relative risk of restenosis for apo E4 carriers was 1.11 (95% CI = 0.87-1.42). In apo E4 carriers, restenosis frequency was similar in those also carrying the ACE D allele and those without (28/55 (50.9%) versus 9/16 (56.2%), P = 0.71) and there was no significant increase in restenosis risk in carriers of both the apo E4 and ACE D alleles compared to the rest (odds ratio 1.30, 95% CI 0.68-2.50, P = 0.39). We conclude that in our cohort, the apo E4 allele does not either independently or acting synergistically with the ACE D allele increase the risk of restenosis after PTCA, and that apo E genotyping will not be a useful predictor of risk before the procedure.

Alleles↗

PubMed1996

A meta-analysis of the association of the deletion allele of the angiotensin-converting enzyme gene with myocardial infarction.

BACKGROUND: The ACE gene is characterized by a polymorphism based on the presence (insertion [I]) or absence (deletion [D]) within intron 16 of a 287-basepair alu repeat sequence, resulting in three genotypes (DD and II homozygotes and ID heterozygotes). In 1992, the DD genotype was reported to be associated with an increased risk of myocardial infarction (MI). Subsequent studies have produced conflicting findings. To further evaluate the association of the ACE I/D genotype with MI risk, we carried out a meta-analysis of all the published studies. METHODS AND RESULTS: In total, 15 studies containing 3394 MI cases and 5479 control subjects were analyzed. The overall distribution of genotypes in the control subjects was 22.7% II, 49.0% ID, and 28.3% DD. The mean odds ratio for MI for DD versus ID/II genotypes across all studies was 1.26 (95% CI, 1.15, 1.39; P < .0001). Pairwise odds ratios were 1.36 (95% CI, 1.19, 1.55) for DD and II, 1.24 (95% CI, 1.11, 1.38) for DD and ID, and 1.09 (95% CI, 0.96, 1.23) for ID and II. The relative risk appeared to be increased in Japanese populations (2.55; 95% CI, 1.75, 3.70). CONCLUSIONS: Within the limitations of the available data, the meta-analysis therefore supports an association of the ACE D allele with MI risk and strengthens the justification for further evaluation in appropriately powered studies.

Genotype↗

PubMed1996

Insertion/deletion polymorphism in the angiotensin-converting enzyme gene and risk of and prognosis after myocardial infarction.

OBJECTIVES: We sought to prospectively investigate whether genetic variation at the angiotensin-converting enzyme gene locus defined by an insertion (I)/deletion (D) polymorphism influences the risk of myocardial infarction or prognosis after infarction, or both. BACKGROUND: It has been suggested that the deletion allele of the angiotensin-converting enzyme gene, and specifically the DD genotype, may increase the risk of myocardial infarction, although previous studies have produced conflicting reports. No studies have yet examined the effect of I/D polymorphism on survival after infarction. METHODS: Angiotensin-converting enzyme genotypes in 684 patients with myocardial infarction recruited at the time of the acute event through coronary care units in two centers were compared with those of 537 control subjects recruited from the base populations. All patients were followed up to assess the impact of the angiotensin-converting enzyme genotype on prognosis. RESULTS: We found no difference (p = 0.89) in the genotype distribution between patients and control subjects (patients DD 31%, ID 47%, II 22%; control subjects DD 30%, ID 48%, II 22%). The odds ratio for myocardial infarction for DD compared with II/ID genotype adjusted for age, gender and center was 1.16 (95% confidence interval [CI] 0.82 to 1.65, p = 0.44). The study had 90% power to detect a 1.5-fold increase in risk of myocardial infarction associated with the DD genotype. For one center, data were available for other risk factors (hypertension, diabetes, angina, previous myocardial infarction, smoking, body mass index, total and high density lipoprotein cholesterol) in both patients and control subjects. In a stepwise logistic regression analysis the odds ratio for DD versus ID/II genotypes remained nonsignificant (1.44, 95% CI 0.84 to 2.46, p = 0.20) for these subjects. Over a median follow-up period of 15 months (range 3 to 22), 155 patients (22.7%) died. There was no difference in mortality between subjects with the DD genotype and those with ID/II genotypes. (21.8% vs. 23.1%, p = 0.25). Likewise, there was no difference in the distribution of survival times in the two groups (p = 0.62). The study had 70% power to detect a 1.5-fold increase in mortality during follow-up associated with the DD genotype. CONCLUSIONS: We conclude that in the groups studied, genetic variation at the angiotensin-converting enzyme gene locus defined by I/D polymorphism does not significantly influence either the risk of or the short- to medium-term prognosis after myocardial infarction.

Aged↗

PubMed1996

Regulation of glutamate dehydrogenase by branched-chain amino acids in skeletal muscle from rats and chicks.

Little information is available regarding the regulation of glutamate dehydrogenase in skeletal muscle. We investigated the regulation of glutamate dehydrogenase by branched-chain amino acids (BCAA) in skeletal muscles from rats and chicks and determined the effects of metabolic acidosis on the activity and regulation of this enzyme by BCAA in rat skeletal muscle. Skeletal muscle mitochondria were prepared from normal rats and chicks and acidotic rats. Mitochondrial glutamate dehydrogenase activity was measured in the presence or absence of BCAA. Metabolic acidosis was induced by feeding rats 1.5% NH4Cl as drinking water. Glutamate dehydrogenase activity was stimulated by leucine (P < 0.001) and isoleucine (P < 0.05) in rat muscles and by leucine (P < 0.05) in chick muscles in a concentration-dependent manner. Both leucine and isoleucine had their maximum effects at a concentration of 1 mM (45% by leucine and 27% by isoleucine in rat muscle; 36% by leucine in chick muscle). The maximum stimulatory effects of leucine and isoleucine in rat muscles were additive. Neither valine nor 2-oxoisocaproate had an effect on glutamate dehydrogenase activity in rat or chick muscles. In acidotic rats, the basal activity of skeletal muscle glutamate dehydrogenase was 1.8-fold (P < 0.01) greater than in control rats; leucine, isoleucine, and valine significantly increased glutamate dehydrogenase activity (maximally 86, 55 and 33%, respectively; P < 0.05). We conclude that glutamate dehydrogenase activity in skeletal muscle from rats and chicks is regulated by BCAA, and that a species difference exists between rats and chicks. Metabolic acidosis increases the activity of glutamate dehydrogenase and its sensitivity to BCAA.

Acidosis↗

PubMed1996

Genetic analysis of thermolabile methylenetetrahydrofolate reductase as a risk factor for myocardial infarction.

Hyperhomocyst(e)inemia is associated with an increased risk of coronary artery disease and myocardial infarction. Both genetic and environmental factors influence the plasma level of homocysteine. One of the metabolic pathways for homocysteine involves the enzyme methylenetetrahydrofolate reductase (MTHFR), which regulates the conversion of homocysteine to methionine. A thermolabile variant of MTHFR is associated with reduced enzyme activity and increased plasma homocysteine levels. Recently, the cause of this variant of MTFHR has been identified as a single base change altering an alanine to a valine residue in the protein. Using a PCR-based assay to distinguish the normal and thermolabile variants of MTHFR in this study, we investigated whether the thermolabile variant is a genetic risk factor for myocardial infarction. In a study of 532 subjects (310 myocardial infarction patients and 222 population-based controls), we found no difference in either MTHFR genotype distribution (p = 0.57) or allele frequencies (p = 0.68) between cases and controls. The allele frequencies of the thermolabile variant were 0.34 and 0.35 in cases and controls, respectively. The age- and sex-stratified odds ratio for risk of myocardial infarction associated with homozygosity for the thermolabile variant was 0.85 (95% CI 0.50-1.50, p = 0.57) and that with carriage of the thermolabile allele was 1.06 (95% CI 0.73-1.52, p = 0.76). The odds ratios remained non-significant when restricted to young subjects (< 60 years) or males, and were not influenced by several other risk factors for myocardial infarction considered either singly or in combination. Interestingly, in both cases and controls, there was a trend toward a higher prevalence of hypertension in subjects carrying the normal allele, although as this is a post-hoc finding it needs to be interpreted with caution. The thermolabile variant of MTHFR is not a major risk factor for myocardial infarction and is unlikely to explain a significant proportion of the reported association of hyperhomocyst(e)inemia with coronary artery disease.

Adult↗

PubMed1996

Helicobacter pylori seropositivity in subjects with acute myocardial infarction.

OBJECTIVE: To determine whether Helicobacter pylori infection increases the risk of myocardial infarction. DESIGN: Case-control study. SETTING: University teaching hospital. METHODS: Serological evidence of H pylori infection was determined in 342 consecutive patients with acute myocardial infarction admitted into the coronary care unit and in 236 population-based controls recruited from visitors to patients on medical and surgical wards. RESULTS: 206/342 (60.2%) of cases were H pylori positive compared with 132/236 (55.9%) of controls (P = 0.30). Age and sex stratified odds ratio for myocardial infarction associated with H pylori seropositivity was 1.05 (95% CI 0.7 to 1.53, P = 0.87) and this remained non-significant (P = 0.46) when other risk factors for ischaemic heart disease were taken into account using logistic regression analysis. H pylori seropositivity was not associated with several coronary risk factors in either cases or controls. CONCLUSION: No increase was found in H pylori seropositivity in subjects with acute myocardial infarction. This suggests that previous H pylori infection is not a major risk factor for acute myocardial infarction.

Aged↗

PubMed1996

Skeletal and cardiac muscle protein turnover during short-term cold exposure and rewarming in young rats.

Young animals exposed to cold environmental temperatures typically have decreased skeletal muscle accretion but increased heart masses. To explore these phenomena, we measured protein synthesis and degradation in vivo in cardiac and skeletal muscle in weanling rats during short-term cold exposure and rewarming. Control rats were housed at 25 degrees C throughout the experiment. Ad libitum-fed and pair-fed (to the intake of controls) rats were housed at 5 degrees C (cold) for 5 days and then at 25 degrees C (rewarmed) for another 5 days. Cold exposure decreased rates of protein accretion and synthesis in skeletal muscle, whereas degradation did not differ. The effects of cold exposure on skeletal muscle were similar in both pair-fed and ad libitum-fed rats, except growth was lower in pair-fed rats. In cardiac muscle, cold exposure increased rates of protein synthesis and degradation and resulted in increased cardiac mass. Results in pair-fed animals generally fell between those of control and ad libitum-fed cold rats. During rewarming, growth rates were not higher in skeletal muscle in ad libitum-fed re-warmed rats, although protein turnover returned toward control values; in pair-fed rats, it remained lower. In heart, growth rates of ad libitum-fed and pair-fed rewarmed rats decreased due to lower protein synthesis rates. These alterations appear to be consistent with a strategy designed to improve survival in cold environments.

Acclimatization↗

PubMed1996

Analysis of quantitative trait loci for blood pressure on rat chromosomes 2 and 13. Age-related differences in effect.

Previous studies have suggested the presence of quantitative trait loci (QTLs) influencing blood pressure on rat chromosomes 2 and 13. In this study, we mapped the QTLs in F2 rats derived from a cross of the spontaneously hypertensive rat and the Wistar-Kyoto rat and analyzed the effect of the QTLs on blood pressures measured longitudinally between 12 and 25 weeks of age. We analyzed 16 polymorphic markers spanning 147.3 cM on chromosome 2 and 13 markers spanning 91.6 cM on chromosome 13. Both chromosomes contained QTLs with highly significant effects on blood pressure (peak logarithm of the odds [LOD] scores, 5.64 and 5.75, respectively). On chromosome 2, the peak was localized to a position at anonymous marker D2Wox7, 2.9 cM away from the gene for the sodium-potassium ATPase alpha 1-subunit. On chromosome 13, the major peak coincided with the marker D13Mit2, 21.7 cM away from the renin gene, but there was a suggestion of multiple peaks. The effect of the QTL on chromosome 2 was seen throughout from 12 to 25 weeks of age, whereas interestingly, the effect for the QTL on chromosome 13 was maximal at 20 weeks of age but disappeared at 25 weeks of age, presumably because of the effect of either epistatic factors or environmental influences. The findings provide important information on QTLs influencing blood pressure on rat chromosomes 2 and 13 that will be useful in localizing and identifying the causative genes and emphasize the importance of age being taken into account when the effects of individual QTLs on a trait that shows significant age-related changes are being analyzed.

Aging↗

PubMed1996

Dorsal midline proboscis associated with diastematomyelia and tethered cord syndrome. Case report.

There have been sporadic reports on tail proboscis, a vestigial appendage, as part of sacrococcygeal dysraphism. The case the authors present, different from the tail proboscis, is the first report linking a proboscis containing a hemilipomyelomeningocele with tethered cord syndrome, associated with diastematomyelia. Tethering was caused by the diastematomyelia that anchored the split spinal cord. The authors emphasize the importance of prompt diagnostic and therapeutic measures for treatment of this condition.

Child, Preschool↗

PubMed1996

Continuous infusion of adrenocorticotropin elevates circulating lipoprotein cholesterol and corticosterone concentrations in chickens.

The purpose of the present study was to investigate the effects of elevated corticosterone (CORT) on circulating lipoprotein cholesterol during a 1-wk period. For this study, 15 commercial broilers were randomly assigned to one of three treatment groups. Group 1 served as the control (CON) and received no treatment, whereas Groups 2 and 3 received subcutaneous mini-osmotic pumps containing either physiological saline (PS) or adrenocorticotropin (ACTH), respectively. The ACTH was delivered at a rate of 8 IU/kg of BW/d. Blood samples were taken at Time 0 (before implants) and on Days 2, 4, and 7 postimplantation. Continuous infusion of ACTH increased plasma glucose, cholesterol, triglycerides, very low density lipoprotein cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, and CORT during the postimplantation period. The group treated with ACTH also exhibited a decrease in BW during the last 2 sampling d. There were no differences in any of the serum constituents measured between CON and PS birds, which suggest that CON birds can serve as useful controls. These data suggest that birds given a continuous infusion of ACTH at 8 IU/kg of BW/d can experience changes in plasma lipoprotein cholesterol concentrations along with changes in other blood parameters and may serve as a useful model in accelerated lipoprotein production.

Adrenocorticotropic Hormone↗

PubMed1996

Radiological evaluation of the interfaces after cemented total hip replacement. Interobserver and intraobserver agreement.

Three radiological methods are commonly used to assess the outcome of total hip replacement (THR). They aim to record the appearance of lucent areas and migration of the prosthesis in a reproducible manner. Two of them were designed to monitor the implant through time and one to grade the quality of cementing. We have measured the level of inter- and intraobserver agreement in all three systems. We randomised 30 patients to receive either finger packing or retrograde gun cementing during Charnley hip replacements. The postoperative departmental radiographs were evaluated in a blinded study by two orthopaedic trainees, two consultants and two experts in THR. The trainees and consultants repeated the exercise at least two weeks later. We used the unweighted kappa statistic to establish the levels of agreement. In general, intraobserver agreement was moderate but interobserver agreement was poor, with levels similar to or less than those expected by chance. Our results indicate that such systems cannot provide reliable data from centres in different parts of the world, with various levels of surgeon evaluating radiographs at differing time intervals. We discuss the problem and suggest some methods of improvement.

Bone Cements↗

PubMed1996

Basilar and distal vertebral artery occlusive disease: correlation of MR imaging and MR angiography.

The purpose of this study is to evaluate the correlation of brain lesions seen on magnetic resonance imaging with vascular occlusive disease of the basilar and distal vertebral arteries as documented on MR angiography. The clinical findings are also correlated with the findings on MR imaging and MR angiography. The clinical records of twenty-one patients with proven occlusive disease of the distal vertebral and/or basilar arteries were retrospectively reviewed. All the patients were imaged utilizing either the Siemens Magnetom 1.5 T SP 4000 and the Siemens 1.0 T Impact systems. Dual MR angiographic techniques were employed including two-dimensional (2D) and three-dimensional time-of-flight. The 2D sequences utilized fast low angle shot gradient echo sequences. The 3D sequences utilized fast image steady-state precession gradient echo sequences. Gadolinium contrast was utilized for increased angiographic detail in one patient. Magnetization transfer contrast was used in three patients. The individual partitions as well as the maximum intensity pixel projection images were evaluated in each case. The most extensive brain lesions were seen in the group of patients with severe basilar and/or combined vertebrobasilar disease. One-half of these patients showed non-specific scattered foci of T2 lengthening similar to the findings found in a group of patients with noncritical stenosis. MR imaging invariably demonstrated more lesions than were clinically suspected. Even though the brain lesions tended to be more extensive in patients with severe vascular disease, the amount of brain tissue damage was not an adequate parameter to document the degree of vascular narrowing. The degree of vascular narrowing was useful in therapy planning. Such data was obtained by the MR angiograms, but not by MR imaging. MR angiography is a useful complementary examination when lesions in the basilar and distal vertebral vascular territories are diagnosed on MR imaging. MR angiography can differentiate critical from noncritical stenosis and can thus play a key role in the therapeutic decision making process.

Adult↗