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Comparative Study
. 2024 Jun 14:51:e20243632.
doi: 10.1590/0100-6991e-20243632-en. eCollection 2024.

Accuracy of duplex ultrasonography versus angiotomography for the diagnosis of extracranial internal carotid stenosis

[Article in English, Portuguese]
Raul Muffato Daolio  1 , Luiz Fernando Santetti Zanin  1 , Carolina Dutra Queiroz Flumignan  2 , Nicolle Cassola  1 , Henrique Jorge Guedes Neto  1 , José Eduardo Mourão Santos  3 , Jorge Eduardo Amorim  1 , Luís Carlos Uta Nakano  1 , Ronald Luiz Gomes Flumignan  1
Affiliations
Comparative Study

Accuracy of duplex ultrasonography versus angiotomography for the diagnosis of extracranial internal carotid stenosis

[Article in English, Portuguese]
Raul Muffato Daolio et al. Rev Col Bras Cir. .

Abstract
in English, Portuguese

Introduction: Internal carotid artery (ICA) stenosis causes about 15% of ischemic strokes. Duplex ultrasonography (DUS) is the first line of investigation of ICA stenosis, but its accuracy varies in the literature and it is usual to complement the study with another more accurate exam when faced with significant stenosis. There is a lack of studies that compare DUS with angiotomography (CTA) in the present literature.

Methods: we performed an accuracy study, which compared DUS to CTA of patients in a tertiary hospital with a maximum interval of three months between tests. Patients were selected retrospectively, and two independent and certified vascular surgeons evaluated each image in a masked manner. When there was discordance, a third evaluator was summoned. We evaluated the diagnostic accuracy of ICA stenosis of 50-94% and 70-94%.

Results: we included 45 patients and 84 arteries after inclusion and exclusion criteria applied. For the 50-94% stenosis range, DUS accuracy was 69%, sensitivity 89%, and specificity 63%. For the 70-94% stenosis range, DUS accuracy was 84%, sensitivity 61%, and specificity 93%. There was discordance between CTA evaluators with a change from clinical to surgical management in at least 37.5% of the conflicting reports.

Conclusion: DUS had an accuracy of 69% for stenoses of 50-94% and 84% for stenoses of 70-94% of the ICA. The CTA analysis depended directly on the evaluator with a change in clinical conduct in more than 37% of cases.

Introdução:: a estenose da artéria carótida interna (ACI) causa cerca de 15% dos acidentes vasculares cerebrais isquêmicos. A ultrassonografia duplex (USD) é a primeira linha de investigação da estenose de ACI, mas sua acurácia varia na literatura e é comum complementar o estudo com outro exame de maior acurácia diante de estenose significativa. Há uma escassez de estudos que comparem a USD com a angiotomografia computadorizada (ATC) na literatura atual.

Métodos:: realizamos um estudo de acurácia, que comparou a USD à ATC de pacientes de um hospital terciário com um intervalo máximo de três meses entre os exames. Os pacientes foram selecionados retrospectivamente e dois cirurgiões vasculares independentes e certificados avaliaram cada imagem de maneira mascarada. Quando houve discordância, um terceiro avaliador foi convocado. Avaliou-se a precisão diagnóstica da estenose da ACI de 50-94% e 70-94%.

Resultados:: foram incluídos 45 pacientes e 84 artérias após a aplicação dos critérios de inclusão e exclusão. Para a faixa de estenose de 50-94%, a acurácia da USD foi 69%, sensibilidade 89% e especificidade 63%. Para a faixa de estenose de 70-94%, a acurácia da USD foi 84%, sensibilidade 61% e especificidade 93%. Ocorreu discordância entre avaliadores da ATC com mudança de conduta clínica para cirúrgica em pelo menos 37,5% dos laudos conflitantes.

Conclusão:: a USD teve uma acurácia de 69% para estenoses de 50-94% e de 84% para estenoses de 70-94% da ACI. A análise das ATC dependeu diretamente do avaliador com mudança de conduta clínica em mais de 37% dos casos.

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Conflict of interest statement

Conflict of interest: no.

Figures

Figure 1
Figure 1. Duplex ultrasound of carotid stenosis. A: right internal carotid artery with stenosis greater than 70%. B: left internal carotid artery with stenosis less than 50% (criteria from Grant et al 2003 11 ).
Figure 2
Figure 2. CT angiography of right internal carotid stenosis greater than 70%. A: transverse section at the point of greatest stenosis. B: transverse section at the point of normal artery distal to the stenosis (NASCET stenosis: BA/B*100 17 ).
Figure 3
Figure 3. Patient flow diagram.
Figure 4
Figure 4. ROC curve of the 70%-94% stenosis range. AUC: area under the curve; IVEP: visual dependence index of postural stability.
Figure 5
Figure 5. Dispersion between duplex ultrasound examiners. The X axis shows the number of arteries and the Y axis, the peak systolic velocity (PSV) in cm/s.
Figure 6
Figure 6. Dispersion between CTA examiners, with the points of each artery with discordance, the X axis being the number of arteries and the Y axis being the stenosis value. A: distribution of arteries with disagreement - Examiner 1; B: distribution of arteries with disagreement - Examiner 2.
See this image and copyright information in PMC

References

    1. Cortesi PA, Fornari C, Madotto F. Trends in cardiovascular diseases burden and vascular risk factors in Italy The Global Burden of Disease study 1990-2017. Eur J Prev Cardiol. 2021;28(4):385–396. doi: 10.1177/2047487320949414. - DOI - PubMed
    1. Brant LCC, Nascimento BR, Veloso GA. Burden of Cardiovascular diseases attributable to risk factors in Brazil data from the "Global Burden of Disease 2019" study. Rev Soc Bras Med Trop. 2022;55(Suppl 1):e0263–e2021. doi: 10.1590/0037-8682-0263-2021. - DOI - PMC - PubMed
    1. Roth GA, Mensah GA, Johnson CO. Global Burden of Cardiovascular Diseases and Risk. Factors, 1990- 2019:Update–Update. doi: 10.1016/j.jacc.2020.11.010. - DOI
    1. Avan A, Digaleh H, Di Napoli M. Socioeconomic status and stroke incidence, prevalence, mortality, and worldwide burden an ecological analysis from the Global Burden of Disease Study 2017. BMC Med. 2019;17(1):191–191. doi: 10.1186/s12916-019-1397-3. - DOI - PMC - PubMed
    1. Flumignan CDQ, Flumignan RLG, Navarro TP. Estenose de carótida extracraniana revisão baseada em evidências. Rev. Col. Bras. Cir. 2017;44(3):293–301. doi: 10.1590/0100-69912017003012. - DOI - PubMed

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