These data demonstrate significant relationships between carotid artery ultrasound plaque characteristics and ischemic cerebrovascular events. These findings encourage further prospective studies in asymptomatic subjects focused on echographic carotid plaque characteristics as predictors of subsequent TIA or stroke.

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To quantify the within-and between-reader agreement of carotid B-mode ultrasonography and angiography interpretation, images from 117 patients examined by both modalities were read multiple times. Angiographic measurements were more reproducible than those of B-mode scans for all parameters except lesion width, but variations for B-mode scan measurements were similar to those for angiographic measurements. Within-reader agreement on the presence of u Ice rat ion was substantial for both modalities, whereas between-reader agreement was poor for B-mode scan and only moderate for angiography. (Stroke 1987;18:1011-1017 V ascular ultrasonography is a minimally invasive technique, with no known risks, that can be used to evaluate individuals for clinically significant atherosclerosis and possibly to measure and track atherosclerosis in nonsymptomatic populations. To establish the capabilities of high-resolution B-mode ultrasound imaging (B scans) for detecting and quantifying atherosclerotic lesions in carotid and iliofemoral arteries of humans and animal models, a multicenter contract was issued by the National Heart, Lung, and Blood Institute (NHLBI). Five clinical centers received contract awards. An additional contract was awarded for a parallel study in primates and another for a data coordinating center. A 5-year research plan was begun in May 1981. The program was divided into 5 phases: protocol development (6 months), pilot studies (6 months), data collection including follow-up studies (36 months), and data analysis and manuscript preparation (12 months).A Steering Committee composed of the principal investigators from each institution and scientific representatives from the NHLBI first met in June 1981 to begin developing formal hypotheses, common proto- Received January 5, 1987; accepted June 24, 1987. cols, operation manuals, and criteria for patient eligibility. The following goals were established: 1) determination of the sensitivity, specificity, and accuracy of B scan with respect to angiography; 2) determination of the sensitivity, specificity, and accuracy of B scan and angiography with respect to pathologic specimen measurements; 3) evaluation of capabilities of B scan and angiography for detecting lesions of varying composition based on gross and microscopic examination of specimens; and 4) establishment of reproducibility in interpreting B scans and angiograms. Subjects and Methods Study DesignTwo studies were initiated. The first was a sensitivity/specificity (S/S) study that was designed to compare results between ultrasonography, angiography, and pathology. The results of the S/S study are reported separately.' The second was a repeatability/variability (R/V) study to evaluate within-reader variation (repeatability) and between-reader variation (variability) within a modality. This paper details the results of this second study, which was designed to determine the capabilities of different diagnostic methodologies. These results are based on multiple readings of single images, and thus the t...

The ability of high-resolution ultrasound, angiography, and pathologic examination of endarterectomy specimens to identify and quantitate atherosclerosis was compared in a five-center study. The carotid bifurcation in 900 patients was evaluated by angiography and ultrasound. In 216 cases, high-quality endarterectomy specimens were available for comparison with the preoperative images. All comparisons were made in a blinded fashion. Results indicate that ultrasound is able to differentiate angiographically normal from abnormal arteries with a sensitivity of 88% (1077 of 1233 arteries) and accuracy of 79% (1251 of 1578 arteries). Angiographic stenoses equal to or greater than 50% diameter were accurately identified by ultrasound imaging in 72% (1133 of 1578 arteries) of cases, and this was improved by the addition of other functional data (i.e., Doppler spectral analysis and oculoplethysmography). There was only modest correlation of absolute measurements of lesion width, minimal lumen, and standard lumen by the two imaging techniques (r = 0.28 to 0.55). Ultrasound measurements of lesion width were on the average 2 mm greater than those of angiography. The lumen averaged 1.5 mm larger when measured by ultrasound techniques. In the subset in which data were available from endarterectomy specimens, ultrasound showed the best correlation with lesion width (mean difference -1.1 mm) and angiography correlated best with minimal lumen (mean difference -0.1 mm). Neither examination consistently identified ulcerated plaques. Although ultrasound imaging alone has limited usefulness in quantitating luminal stenosis, this can be improved by the use of Doppler spectral analysis and oculoplethysmography. Ultrasound is superior to angiography for quantifying atherosclerotic plaque (lesion width) and will be an important tool for further study of atherosclerotic lesions.

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