Carotid Artery Stenosis: Grayscale and Doppler Ultrasound Diagnosis???Society of Radiologists in Ultrasound Consensus Conference

Abstract

The Society of Radiologists in Ultrasound convened a multidisciplinary panel of experts in the field of vascular ultrasonography (US) to come to a consensus regarding Doppler US for assistance in the diagnosis of carotid artery stenosis. The panel's consensus statement is believed to represent a reasonable position on the basis of analysis of available literature and panelists' experience. Key elements of the statement include the following: First, all internal carotid artery (ICA) examinations should be performed with grayscale, color Doppler, and spectral Doppler US. Second, the degree of stenosis determined at grayscale and Doppler US should be stratified into the categories of normal (no stenosis), less than 50% stenosis, 50 to 69% stenosis, > or =70% stenosis to near occlusion, near occlusion, and total occlusion. Third, ICA peak systolic velocity (PSV) and the presence of plaque on grayscale and/or color Doppler images are primarily used in the diagnosis and grading of ICA stenosis. Two additional parameters (the ICA-to-common carotid artery PSV ratio and ICA end diastolic velocity) may also be used when clinical or technical factors raise concern that ICA PSV may not be representative of the extent of disease. Fourth, ICA should be diagnosed as normal when ICA PSV is less than 125 cm/second and no plaque or intimal thickening is visible, less than 50% stenosis when ICA PSV is less than 125 cm/second and plaque or intimal thickening is visible, 50 to 69% stenosis when ICA PSV is 125 to 230 cm/second and plaque is visible, > or =70% stenosis to near occlusion when ICA PSV is more than 230 cm/second and visible plaque and lumen narrowing are seen, near occlusion when there is a markedly narrowed lumen on color Doppler US, and total occlusion when there is no detectable patent lumen on grayscale US and no flow on spectral, power, and color Doppler US. Fifth, the final report should discuss velocity measurements and grayscale and color Doppler findings. Study limitations should be noted when they exist. The conclusion should state an estimated degree of ICA stenosis as reflected in these categories. The panel also considered various technical aspects of carotid US and methods for quality assessment, and identified several important unanswered questions meriting future research.

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“…13 No significant stenosis was measured, and there was no significant differences between the groups.…”

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“…Carotid ultrasound can localize the plaque, and identify its length, composition, and surface. Further Doppler information on peak systolic and end-diastolic velocities, and ICA/common carotid artery ratio is further used to predict the North American carotid artery stenosis range [29]. Although the 2 large carotid endarterectomy trials, the European Carotid Surgery Trial (ECST) and the North American Symptomatic Carotid Endarterectomy Trial (NASCET) applied different methodologies to calculate the percent diameter reduction of the tightest residual lumen [30,31], the current recommendation is that the percent diameter reduction should be measured relative to …”

“…• Radiation exposure (Table 3) [29]. The criteria are recommended for use by new ultrasound laboratories in development and selfvalidating studies of local interpretation criteria, and as a comparator criteria for established laboratories, because in the experience of participating experts, most accurate local criteria should be quite similar (i.e., with a 10-20% difference from values identified in Table 3).…”

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