4-Dimensionally Guided 3-Dimensional Color-Doppler Ultrasonography Quantifies Carotid Artery Stenosis With High Reproducibility and Accuracy

Abstract

The 4D/3DC-US method provides reliable and accurate stenosis quantification and binary classification with good diagnostic accuracy compared with CA and DUS.

Improved Carotid Stenosis Quantification on Novel 4D/3D-Doppler Ultrasonography Indexing to the Common Carotid Artery

“…Enrollment for this bicentric prospective evaluation was as recently described at the University of Freiburg and the University Heart Center Freiburg -Bad Krozingen [7]. Out of 216 prescreened individuals, only 101 patients signed the informed consent to allow for the screening and study examinations, mostly because they did not accept the proposed treatment including angiography as a whole or they switched to surgery or best medical therapy alone [7]. Therapeutic recommendations were based on a multidisciplinary board's decision and were independent of ultrasonographic research imaging.…”

“…Therapeutic recommendations were based on a multidisciplinary board's decision and were independent of ultrasonographic research imaging. After anonymization, further selection was performed applying inclusion and exclusion criteria followed by the final study examinations with 4D/3DC-US, DUS and angiography by independent observers on 80 patients [7]. Lack of informed consent (115), clinical contraindications (8), and insufficient image quality including acoustic shadowing and pseudoocclusions (13 patients) were the reason for exclusion as previously published in detail [7].…”

“…In contrast to 2D ultrasonography, 3D color Doppler ultrasonographic morphometry allows for multiplanar rendering of vessel segments enabling centerline adjusted measurements. Recently we demonstrated that four-dimensionally (4D) guided three-dimensional color Doppler ultrasonography (4D/3DC-US) is a reproducible and accurate new modality for morphometric percent-ICAS (%-ICAS) measurement [7]. This investigation was based on the established North American Society of Carotid Endarterectomy Trialists' (NAS-CET) approach relating the residual lumen diameter to healthy distal segments (▶ Fig.…”

“…This investigation was based on the established North American Society of Carotid Endarterectomy Trialists' (NAS-CET) approach relating the residual lumen diameter to healthy distal segments (▶ Fig. 1) [7]. While the angiographically defined NASCET method of %-ICAS has become a global standard in diagnostics, alternative grading methods were suggested to solve associated problems (▶ Fig.…”

“…We intended to evaluate the CC and ECST stenosis definitions that could be an alternative in clinical practice, especially in cases when NASCET is not applicable. Innovative 4D/3DC-US was used prospectively in a cohort that was previously used for analysis of the %-NASCET method [7]. Our hypothesis was that stenosis grading by the ECST and CC approaches is not inferior to the established NASCET definition.…”