CT-angiography and doppler ultrasonography in atherosclerotic carotid artery disease. A comparative study (original) (raw)
Related papers
Objective-The main objective of the study was to diagnose carotid artery stenosis (CAS) by high resolution ultrasonography (HRUSG) and CT angiography (CTA) and to compare the findings with Digital subtraction angiography (DSA). Introduction-CAS is one of the important causes of stroke so diagnosis and characterization of CAS is a crucial step in management of stroke. Many modalities have come up for diagnosis of CAS, of which DSA is considered gold standard. In this study, we aim to evaluate the reliability of USG and CTA (non-invasive technique) for detection of CAS and compare with gold standard DSA which is an invasive technique. Materials and methods-An institution based correlation study was performed on 33 patients presenting with stroke and TIA in the department of Neuromedicine who were sent to the department of Radiodiagnosis for evaluation of CAS by HRUSG and CTA and then DSA was done in those patients who were found to have >50% stenosis of carotid artery. Result-Both HRUSG and CTA showed good correlation with DSA in detecting CAS. Conclusion-CTA can be used as an alternative of DSA when combined with HRUSG in early cases and DSA should be reserved for patients when non-invasive imaging techniques have yielded discordant results or patient is planned for therapeutic intervention.
Journal of Health Sciences, 2013
Introduction: The aim of this research was to compare specifi city and sensitivity of Color Doppler ultrasonographywith CT angiography.Methods: A total of one hundred patients suffering from carotid artery disease (n=200) were tested in this research in the period from June till October, 2011. Average age of the patients was 61.5 years, and most of the patients were in the age group ranging from 55 to 65 years. The level of carotid artery stenosis is measured according to Standards of the North America Symptomatic Carotid Endarterectomy Trail study,by method of Color Doppler ultrasonography and CT angiography.Results: Stenosis <50% registered by Doppler ultrasonography was found in 62% and by CT angiography in 64% patients. Stenosis from 70 to 79% registered by Doppler ultrasonography was found in 88% and by CT angiography in 82% patients. In patients with level of stenosis 70-79% there was a tendencyof registering the stenosis to be higher by Color Doppler ultrasonography, than ...
Haseki Tıp Bülteni, 2019
The aim of this study was to investigate the correlation between the severity of carotid stenosis determined with 64-multidetector row computed tomographic angiography (CTA) (64-MDCTA) using the ''common carotid'' (CC) method and color Doppler ultrasound (CDUS) findings. Methods: Two hundred and eighty-six internal carotid arteries (ICAs) of 143 patients with a history of transient ischemic attack/ stroke and suspected ICA stenosis who were referred for cervical CTA were examined. Plaque location, plaque type and stenosis severity were reported with CDUS and CTA. Stenosis severity was calculated with CTA using the CC method. The results were compared retrospectively. Results: Plaques were observed in a total of 202 (72.2%) ICAs by CDUS and using MDCTA in a total of 200 (71.4%) ICAs. The plaques were classified according to the plaque type as soft, calcified and mixed by CDUS and by MDCTA Stenosis ≥70% was observed in 12.2% of cases on CDUS and in 10.0% of cases on CTA. A correlation of 91% (r=91, p<0.001) was observed between findings of CDUS and CTA for the determination of the grade of carotid stenosis. Conclusion: Stenosis measurement done using the CC method is highly correlated with CDUS findings. The CC method is a candidate for widespread use in carotid stenosis measurement in routine practice.
Introduction: Accurate non-invasive carotid imaging is important for effective secondary stroke prevention. We conducted a systematic review and meta-analysis to compare DUS and CTA accuracy for diagnosing (70-99%) carotid artery stenosis. Methodology: A systematic search was conducted in PubMed and Embase from February, 2021, to March, 2021, to compare diagnostic test accuracy of DUS and CTA. The stated method for determining the degree of stenosis (e.g., NASCET or ECST) Results: In 23 included studies with 3229 participants, the pooled sensitivity for CTA test is 0.79 [0.72, 0.85], and the pooled specificity is 0.93 [0.84, 0.97]. We also found that the pooled sensitivity for DUS test is 0.90 [0.80, 0.95], and the pooled specificity is 0.87 [0.75, 0.94]. Regarding the CTA test, most of the points gathered around the top left of the graph, with the area under the curve of 0.87 [0.84-0.90], indicate the test's good accuracy. For the DUS test, most of the points clustered around the top left of the graph, with area under the curve of 0.95 [0.92-0.95], indicating high accuracy of the test. Conclusion: We found relatively high sensitivity and specificity of both CTA and DUS tests. However, the DUS test's accuracy in diagnosing (70-99%) carotid artery stenosis was greater than CTA.
Journal of Neuroimaging, 2018
The purpose of this study was to compare Doppler ultrasound (DUS) to other angiographic modalities: computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA). METHODS: All DUS studies performed at Stroke Prevention Clinic (SPC) from 2011 to 2013 and referred for further angiographic modalities were included. Patients were excluded if the corresponding angiographic modality was not performed within 6 months of DUS. Patients were also excluded if they underwent interventions before DUS or between the time of DUS and the corresponding angiographic modality. The degree of stenosis was classified as mild (<50%), moderate (50-69%), severe (70-99%), or occlusion (100%). RESULTS: In total, 245 patients were identified. Nine patients were excluded (3.7%). Overall 472 Doppler studies of single ICAs from 236 patients were included in our analysis. Age was 65 ± 13 years and 136 patients were males (57.6%). There was an excellent agreement between DUS and CTA (kappa = .9 [P < .001], n = 274), good agreement with MRA (kappa = .8 [P < .001], n = 242), and excellent agreement with DSA (kappa = .92 [P < .001], n = 18). There was excellent agreement between CTA and MRA (kappa = .87, n = 46). CONCLUSION: Doppler ultrasound performed in a dedicated SPC by an experienced sonographer and reviewed by a certified stroke neurologist serves as a reliable initial screening tool in determining carotid artery stenosis.
2012
Purpose. This study was undertaken to prospectively evaluate the diagnostic performance of colour Doppler ultrasonography (CDUS), first-pass (FP) and steady-state (SS) contrast-enhanced magnetic resonance angiography (MRA) and computed tomography angiography (CTA) of the carotid arteries using digital subtraction angiography (DSA) as the reference standard. Materials and methods. A total of 170 patients with previous cerebrovascular events and suspected carotid artery stenoses underwent CDUS, blood-pool MRA, CTA and DSA. Accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for CDUS, FP MRA, SS MRA and CTA. The McNemar and Wilcoxon tests and receiver operating characteristic (ROC) curve analysis were used to determine significant differences (p<0.05) between the diagnostic performances of the four modalities, and the degree of stenosis was compared using linear regression. Results. A total of 336 carotid bifurcations were studied. The area under the curve (AUC) for degree of stenosis was: CDUS 0.85±0.02, FP MRA 0.982±0.005, SS MRA 0.994±0.002 and CTA 0.997±0.001. AUC analysis showed no statistically significant difference between CTA and MRA (p=0.0174) and a statistically significant difference between CDUS and the other techniques (p<0.001). Plaque morphology analysis showed no significant difference between CTA and SS MRA; a significant difference was Riassunto Obiettivo. L'obiettivo di questo studio è stato di valutare prospetticamente l'accuratezza dell'eco-color Doppler (ECD), dell'angiografia con risonanza magnetica (angio-RM), ottenuta con sequenze di primo passaggio (PP) ed allo stato stazionario (SS) e dell'angiografia con tomografia computerizzata (angio-TC) nella diagnostica della stenosi carotidea utilizzando l'angiografia con sottrazione digitale (DSA) come metodica di riferimento. Materiali e metodi. Centosettanta pazienti sintomatici e con sospetta stenosi carotidea sono stati sottoposti ad ECD, angio-RM, angio-TC e DSA. Accuratezza, sensibilità, specificità, valore predittivo positivo (VPP) e valore predittivo negativo (VPN) sono stati calcolati per ECD, angio-RM ed angio-TC. Le differenze di performance tra le metodiche sono state valutate utilizzando il test di McNemar, il test di Wilcoxon e l'analisi delle curve receiver operating characteristic (ROC) (p<0,05). Inoltre il valore di stenosi attribuito dalla valutazione dell'ECD, dell'angio-RM e dell'angio-TC è stato confrontato con il valore della DSA tramite regressioni lineari. Risultati. Sono state valutate 336 biforcazioni carotidee. Per la valutazione del grado di stenosi è stata calcolata l'area sotto la curva (AUC) delle quattro metodiche che è risultata: ECD 0,85±0,02, angio-RM PP=0,982±0,005, angio-RM SS=0,994±0,002 ed angio-TC=0,997±0,001 con sostanziale equivalenza tra angio-TC ed angio-RM (p=0,0174) ed una differenza statisticamente significativa VASCULAR AND INTERVENTIONAL RADIOLOGY RADIOLOGIA VASCOLARE E INTERVENTISTICA
Cerebrovascular Diseases, 2008
Stroke is a leading cause of severe disability in the western world. A correct diagnostic procedure to stratify risk is necessary in order to rapidly plan the most efficient therapy. The purpose of this work was to evaluate the agreement between ultrasound echo-color Doppler (US-ECD) and multidetector-row CT angiography (MDCTA) in determining the degree of carotid stenosis. From January 2004 to February 2007, 187 patients who had previously undergone both US-ECD and MDCTA were studied retrospectively. For each patient, stenosis degree was measured by applying the North American Symptomatic Carotid Endarterectomy Trial criteria. Data derived from MDCTA and US-ECD were then compared to calculate the inter-technique variability by using Cohen kappa statistics. For all plaque types (fatty, mixed and calcified), inter-technique variability was assessed. The Wilcoxon signed-rank test was used to highlight differences between the procedures, and scatterplots were also calculated. As a gold standard, reference surgical comparisons were performed in 50 patients. The percentage of observed agreements in the evaluation of stenosis degree was 72.19% with a kappa value of 0.659 (95% confidence interval: 0.604-0.715) and a weighted kappa of 0.789. After the evaluating stenosis degree in fatty, mixed and calcified plaques, the percentages of observed agreements were 79.31, 74.58 and 64.29%, respectively, with kappa values of 0.738, 0.691 and 0.565. A good agreement between US-ECD and MDCTA in the evaluation of stenosis degree was observed, together with a remarkable difference between the 2 techniques in the assessment both of calcified plaques and of plaques showing a predominant calcific component.
Acta Neurochirurgica, 2006
Background. A prospective study was performed comparing the accuracy of digital subtraction angiography (DSA) and Doppler ultrasonography (DUS) stenosis findings with measurements on histological specimens. Method. DSA and DUS were used to evaluate carotid stenosis and were compared with measurements on histological specimens. Intact carotid plaques from 123 cases were removed in one piece during surgery. The specimens were histologically processed and examined in transverse sections. The smallest inner and correlating outer diameters were measured and the extent of stenosis was calculated. Carotid artery stenoses were compared and statistics done. Specimens in symptomatic cases were divided into 3 groups: stenosis 30-49% (Group 1), stenosis 50-69% (Group 2) and stenosis 70-99% (Group 3). Specimens in asymptomatic cases were divided into two groups: stenosis 59% (Group A) and stenosis !60% (Group B). Findings. Wilcoxon paired tests revealed significant differences between DSA, DUS and measurements on histological specimens. In severe stenoses only, no significant difference was observed between stenosis measurement according to the European Carotid Surgery Trial (ECST) angiography methodology and measurements on histological specimens. The most pronounced differences were found between angiography methodology of the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and measurements on histological specimens. When investigating how often preoperative measurement classified stenosis into the same Group of stenoses as postoperative measurement, DUS was the most accurate diagnostic tool. Conclusions. This study confirmed our previous results, i.e., angiography underestimates the degree of carotid artery stenosis. DUS seems to be more accurate in classifying stenoses into different groups to the extent of narrowing of the carotid arteries. These results make the position of angiography in diagnostic algorithm of carotid stenoses investigations even more questionable.
Incidence of Carotid Atherosclerosis in Ischemic Stroke Detected by Duplex Ultrasound
The Egyptian Journal of Hospital Medicine
Background: Carotid artery atherosclerosis is one of crucial pathogenetic factors of cerebrovascular disease, such ischemic stroke. The degree of artery stenosis has been regarded as one of the most effective criteria to assess carotid atherosclerotic severity. Color Doppler ultrasound (CDUS) acts as an easy and noninvasive technique to research the characterization of carotid atherosclerotic lesion through echogenicity, which is referred to as the reflectance of the ultrasound signal. Objective: To evaluate the incidence of extracranial carotid atherosclerosis in patients presenting with ischemic stroke using the noninvasive CDUS. Patients and methods: This was a cohort prospective observational clinical study conducted on a total of 80 patients with ischemic stroke, divided into two groups (no atherosclerosis n=12 and atherosclerotic cases=73). The study was conducted at Mansoura University Emergency Hospital through one year period from December 2018 to December 2019. Results: A statistically significant higher median right carotid artery intimal medial thickness among atherosclerotic than non-atherosclerotic group. A statistically significant higher median right carotid artery intimal medial thickness was detected among atherosclerotic than non-atherosclerotic group with median thickness was 0.82 and 0.515, respectively. Median plaque index was 4 ranging from 1.6 to 5.9 and incidence of left carotid artery stenosis was 78.1%. Conclusion: Multiple risk factors like age, sex and high mean arterial blood pressure are strongly associated with carotid artery atherosclerosis, so we suggest that high risk patients should be screened by Doppler ultrasonography in order to plan out medical and surgical intervention for primary and secondary prevention of ischemic stroke.