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The Reliability of Ultrasound Measurements of Carotid Stenosis Compared to MRA and DSA

Published online by Cambridge University Press:  02 December 2014

Colin Honish ,
Venkatraman Sadanand ,
Derek Fladeland ,
Vance Chow  and
Fahrad Pirouzmand
Colin Honish
Affiliation:
Department of Neurosurgery, University of Saskatchewan, Royal University Hospital, Saskatoon, SK, Canada
Venkatraman Sadanand
Affiliation:
Department of Neurosurgery, University of Saskatchewan, Royal University Hospital, Saskatoon, SK, Canada
Derek Fladeland
Affiliation:
Department of Neurosurgery, University of Saskatchewan, Royal University Hospital, Saskatoon, SK, Canada
Vance Chow
Affiliation:
Department of Neurosurgery, University of Saskatchewan, Royal University Hospital, Saskatoon, SK, Canada
Fahrad Pirouzmand*
Affiliation:
Department of Neurosurgery, University of Toronto, Sunnybrook and Women's Health Sciences Center, Toronto, ON, Canada
*
University of Toronto, Sunnybrook and Women’s Health Sciences Center, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5
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Abstract:

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Objective:

Carotid ultrasound (US) is a screening test for patients with transient ischemic attacks (TIAs) or stroke who then undergo Digital Subtraction Angiogram (DSA) or Magnetic Resonance Angiography (MRA). Gold standard DSA is invasive with inherent risks and costs. MRA is an evolving technology. This study compares reliability of MRA and US modes with DSA in determining degree of internal carotid artery stenosis.

Methods:

A five year retrospective analysis of 140 carotid arteries from patients who had carotid US and DSA, and possibly Magnetic Resonance Angiography was undertaken. Recorded US parameters were peak systolic velocity (PSV), end diastolic velocity (EDV), and ICA/CCA peak systolic velocity ratio. The MRA and DSA parameters used NASCET technique for measuring stenosis. Statistical analysis included ROC curves and Kappa computation.

Results:

US grading of carotid stenosis can be made more reliable by choosing appropriate parameters. The best combination of sensitivity and specificity for stenosis > 70% in our hospital was seen at PSV > 173cm/s (sensitivity 0.87, specificity 0.8, Positive Predictive Value (PPV) 0.70, Negative Predictive Value (NPV) 0.93, kappa 0.64 and weighted kappa 0.71). MRA kappa was 0.78, (sensitivity 0.75, specificity 1.0, PPV 1.0, NPV 0.85).

Conclusions:

US parameters should be validated in each centre. At best, US can only approximate the accuracy of DSA, probably due to inherent limitations of this modality. Magnetic Resonance Angiography has a perfect specificity and PPV but this technique needs to be standardized. Simultaneous use of MRA and US for screening increases sensitivity to over 0.9 without compromising specificity in > 70% stenosis.

Résumé:

RÉSUMÉ: Objectif:

L’échographie carotidienne (ÉC) est une épreuve de dépistage chez les patients qui ont subi une ischémie cérébrale transitoire (ICT) ou un accident vasculaire cérébral (AVC) et chez qui on pratique ensuite un angiogramme numérisé (AN) ou un angiogramme par résonance magnétique (ARM). L’étalon or est l’AN qui est un examen effractif avec les risques et les coûts qui y sont associés. L’ARM est une technique en développement. Cette étude compare la fiabilité de l’ARM et de l’ÉC par rapport à l’AN pour déterminer le degré de sténose de la carotide interne (CI).

Méthodes:

Il s’agit d’une étude rétrospective de 140 artères carotides de patients qui ont subi une ÉC et un AN et dont certains ont subi une ARM. Les paramètres enregistrés à l’ÉC étaient la vélocité systolique maximale (VSM), la vélocité en fin de diastole (VFD) et le rapport de la vélocité systolique maximale dans la carotide interne sur celle de la carotide commune (RV). Les critères NASCET ont été utilisés pour mesurer la sténose au moyen des paramètres obtenus par ARM et AN. L’analyse statistique comportait la détermination de la courbe ROC et du coefficient Kappa.

Résultats:

La fiabilité de la détermination du degré de sténose carotidienne par ÉC peut être améliorée par le choix de paramètres appropriés. La meilleure combinaison de sensibilité et de spécificité pour une sténose > 70% dans notre hôpital a été observée à une VSM > 173 cm/s (sensibilité 0,87 ; spécificité 0,8 ; valeur prédictive positive (VPP) 0,70 valeur prédictive négative (VPN) 0,93, Kappa 0,64 et Kappa pondéré 0,71). La valeur Kappa pour l’ARM était de 0,78 (sensibilité 0,75 ; spécificité 1,0 ; VPP 1,0 et VPN 0,85).

Conclusions:

Les paramètres de l’ÉC devraient être validés dans chaque centre. Au mieux, l’ÉC ne peut qu’approcher la précision de l’AN, probablement à cause des limites inhérentes à cette technique. L’ARM a une spécificité et une VPP parfaites, mais cette technique doit être standardisée. L’utilisation simultanée de l’ARM et de l’ÉC pour le dépistage augmente la sensibilité à plus de 0,9 sans compromettre la spécificité pour les sténoses > 70%.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 4 , November 2005 , pp. 465 - 471
Copyright
Copyright © The Canadian Journal of Neurological 2005

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