(Stroke. 1997;28:597-602.)
© 1997 American Heart Association, Inc.
Articles |
Duplex Ultrasound Criteria for the Identification of Carotid Stenosis Should Be Laboratory Specific
From the Departments of Medicine (K.M.K.), Radiology (J.F.P.), and Surgery (A.D.W.), Brigham and Women's Hospital, and the Department of Surgery (J.J.S., K.C.K.), Beth Israel Hospital, Harvard Medical School, Boston, Mass.
Correspondence to K. Craig Kent, MD, Beth Israel Hospital, 330 Brookline Ave, Boston, MA 02215.
Background and Purpose Published criteria for the determination of carotid stenosis have been widely applied by vascular laboratories. We compared two vascular laboratories and their duplex ultrasound (DU) machines in terms of their overall diagnostic performance and the optimal criteria to identify patients who have a 70% to 99% stenosis of the internal carotid artery.
Methods Measurements of stenosis by DU and angiography were compared for 123 carotid arteries (60 arteries, laboratory A; 63 arteries, laboratory B). Receiver operating characteristic (ROC) curves were created, and the areas under the ROC curves and the optimal criteria for determining a 70% to 99% stenosis were compared. Multiple regression analysis was used to measure the effect of laboratory on the relationship between angiographic stenosis and DU velocity parameters.
Results Areas under the ROC curves were similar for both laboratories (0.89 to 0.90, laboratory A; 0.90 to 0.92, laboratory B). However, the optimal criterion for the identification of a 70% to 99% carotid stenosis was different for each laboratory. For most velocity parameters, based on regression analyses, the predicted percent angiographic stenosis for laboratory A was significantly greater than that for laboratory B. In addition, performance differed between the laboratories when established criteria from the literature were applied.
Conclusions Two vascular laboratories with similar diagnostic accuracy by ROC analysis have markedly different "optimal" DU criteria. For a given angiographic stenosis, velocities in one laboratory were consistently greater than those in the other laboratory. Laboratory-specific criteria rather than published criteria should be used to identify patients with internal carotid artery stenoses.
Key Words: carotid stenosis • diagnosis • ultrasonics
This article has been cited by other articles:
 |
|
 |
|
  R. E. Latchaw, M. J. Alberts, M. H. Lev, J. J. Connors, R. E. Harbaugh, R. T. Higashida, R. Hobson, C. S. Kidwell, W. J. Koroshetz, V. Mathews, et al. Recommendations for Imaging of Acute Ischemic Stroke: A Scientific Statement From the American Heart Association Stroke, November 1, 2009; 40(11): 3646 - 3678. [Full Text] [PDF]
|
|
|
|
 |
|
 B. P. Yan, D. J. Clark, M. R. Jaff, T. J. Kiernan, R. M. Schainfeld, S. Lessio, and K. Rosenfield Carotid Duplex Ultrasound Velocity Measurements Versus Intravascular Ultrasound in Detecting Carotid In-Stent Restenosis Circ Cardiovasc Interv, October 1, 2009; 2(5): 438 - 443. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Setacci, E. Chisci, F. Setacci, F. Iacoponi, and G. de Donato Grading Carotid Intrastent Restenosis: A 6-Year Follow-Up Study Stroke, April 1, 2008; 39(4): 1189 - 1196. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. R. Bates, C. J. D. Babb, D. E. Casey, C. U. Cates, G. R. Duckwiler, T. E. Feldman, W. A. Gray, K. Ouriel, E. D. Peterson, K. Rosenfield, et al. ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (ACCF/SCAI/SVMB/SIR/ASITN Clinical Expert Consensus Document Committee on Carotid Stenting) Vascular Medicine, February 1, 2007; 12(1): 35 - 83. [PDF]
|
|
|
|
 |
|
 American Society of Interventional & Therapeutic N, Society for Cardiovascular Angiography and Interve, Society for Vascular Medicine and Biology, Society of Interventional Radiology, E. R. Bates, J. D. Babb, D. E. Casey Jr, C. U. Cates, G. R. Duckwiler, T. E. Feldman, et al. ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (ACCF/SCAI/SVMB/SIR/ASITN Clinical Expert Consensus Document Committee on Carotid Stenting) J. Am. Coll. Cardiol., January 2, 2007; 49(1): 126 - 170. [Full Text] [PDF]
|
|
|
|
 |
|
 M. H. Heijenbrok-Kal, E. Buskens, P. J. Nederkoorn, Y. van der Graaf, and M. G. M. Hunink Optimal Peak Systolic Velocity Threshold at Duplex US for Determining the Need for Carotid Endarterectomy: A Decision Analytic Approach Radiology, December 21, 2005; (2005) 2381041078. [Abstract] [Full Text]
|
|
|
|
|
|
M. H. Heijenbrok-Kal, P. J. Nederkoorn, E. Buskens, Y. van der Graaf, and M.G. Myriam Hunink Diagnostic Performance of Duplex Ultrasound in Patients Suspected of Carotid Artery Disease: The Ipsilateral Versus Contralateral Artery Stroke, October 1, 2005; 36(10): 2105 - 2109. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kamouchi, K. Kishikawa, Y. Okada, T. Inoue, S. Ibayashi, and M. Iida Reappraisal of Flow Velocity Ratio in Common Carotid Artery to Predict Hemodynamic Change in Carotid Stenosis AJNR Am. J. Neuroradiol., April 1, 2005; 26(4): 957 - 962. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. G. Grant, C. B. Benson, G. L. Moneta, A. V. Alexandrov, J. D. Baker, E. I. Bluth, B. A. Carroll, M. Eliasziw, J. Gocke, B. S. Hertzberg, et al. Carotid Artery Stenosis: Gray-Scale and Doppler US Diagnosis--Society of Radiologists in Ultrasound Consensus Conference Radiology, November 1, 2003; 229(2): 340 - 346. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Logason, S. Karacagil, A. Tulga Ulus, and H.-G. Hardemark The Impact of Different Spectral Doppler Criteria on the Proportion of High-Grade Internal Carotid Artery Stenosis in Patients Undergoing Duplex Scanning Angiology, May 1, 2002; 53(3): 297 - 301. [Abstract] [PDF]
|
|
|
|
 |
|
 K. Logason, S. Karacagil, H.-G. Hardemark, A. Bostrom, A. Hellberg, and C. Ljungman Carotid Artery Endarterectomy Solely Based on Duplex Scan Findings Vascular and Endovascular Surgery, January 1, 2002; 36(1): 9 - 15. [Abstract] [PDF]
|
|
|
|
 |
|
 J. M. Serfaty, P. Chirossel, J. M. Chevallier, R. Ecochard, J. C. Froment, and P. C. Douek Accuracy of Three-Dimensional Gadolinium-Enhanced MR Angiography in the Assessment of Extracranial Carotid Artery Disease Am. J. Roentgenol., August 1, 2000; 175(2): 455 - 463. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Visser and M. G. Myriam Hunink Peripheral Arterial Disease: Gadolinium-enhanced MR Angiography versus Color-guided Duplex US-A Meta-analysis Radiology, July 1, 2000; 216(1): 67 - 77. [Abstract] [Full Text]
|
|
|
|
|
|
E. D. Kreske, S. W. Wolk, C. J. Shanley, R. M. Lampman, J. E. Knake, L. A. Lange, E. E. Erlandson, and W. M. Whitehouse Jr Duplex Ultrasonography to Predict Internal Carotid Artery Stenoses Exceeding 50% and 70% as Defined by NASCET: The Need for Multiple Criteria Vascular and Endovascular Surgery, September 1, 1999; 33(5): 497 - 506. [Abstract] [PDF]
|
|
|
|
|
|
O. E. H. Elgersma, M. van Leersum, P. C. Buijs, M. S. van Leeuwen, Y. T. van de Schouw, B. C. Eikelboom, and Y. van der Graaf Changes Over Time in Optimal Duplex Threshold for the Identification of Patients Eligible for Carotid Endarterectomy Stroke, November 1, 1998; 29(11): 2352 - 2356. [Abstract] [Full Text] [PDF]
|
|