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Comparative Study
. 2004 Nov-Dec;25(10):1856-60.

Combined use of color duplex ultrasonography and B-flow imaging for evaluation of patients with carotid artery stenosis

Muharrem Tola  1 , Mehmet Yurdakul, Turhan Cumhur
Affiliations
Comparative Study

Combined use of color duplex ultrasonography and B-flow imaging for evaluation of patients with carotid artery stenosis

Muharrem Tola et al. AJNR Am J Neuroradiol. 2004 Nov-Dec.

Abstract

Background and purpose: Color duplex ultrasonography (CDU) is a standard method of noninvasive evaluation of internal carotid artery stenosis (ICAS). B-flow imaging (BFI), on the other hand, is a newer method. We investigated the accuracy of the two noninvasive tests--CDU and BFI--each separately and as a combination of the two tests by comparing with digital subtraction angiography as a reference standard.

Methods: We performed CDU, BFI, and digital subtraction angiography on 95 consecutive patients with ICAS. Separate and combined test results of CDU and BFI were compared with digital subtraction angiography results.

Results: For identifying 70% to 99% ICAS, as CDU criterion, the ratio of internal carotid artery to common carotid artery peak systolic velocity had the highest diagnostic accuracy (sensitivity, 94%; specificity, 96%). The sensitivity and specificity of BFI were 65% and 98%, respectively. With CDU and BFI, results were concordant in 144 (89%) cases for 70% to 99% ICAS. Sensitivity and specificity of combined CDU and BFI results for identification of ICAS were 95% and 99%, respectively. The misclassification rates of CDU and BFI were 4.7% and 8.1%, respectively. When combined test results were concordant, the misclassification rate decreased to 1.4%.

Conclusion: CDU showed a slightly better accuracy than did BFI in the diagnosis of carotid artery stenosis. Combined use of CDU and BFI is more accurate than use of either test alone.

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Figures

F<sc>ig</sc> 1.
Fig 1.
Graph shows distribution of ICAS according to angiographic interpretation.
F<sc>ig</sc> 2.
Fig 2.
Severe left ICAS in a 68-year-old woman. A, CDU shows >70% ICAS with PSV of 347.5 cm/s, end diastolic velocity of 194.8 cm/s, and ICA to CCA ratio of 11.6. B, 82% of ICAS is measured with BFI. C, Digital subtraction angiography assesses 83% stenosis.
See this image and copyright information in PMC

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