Comparison of ultrasonography, CT angiography, and digital subtraction angiography in severe carotid stenoses

Abstract

Digital subtraction angiography (DSA) is considered to be the 'gold standard' for confirmation of severe (70-99%) stenoses of internal carotid arteries (ICAs). However, it is associated with a risk of complications. The aim of this study was to assess the accuracy of ultrasonography (US), computed tomographic angiography (CTA), and their combined use for the detection and quantification of severe carotid stenoses, when compared with DSA. Severe ICA stenoses were diagnosed by US in a set of 29 patients. All patients also underwent CTA and DSA. Sensitivity, specificity, positive (PPV), negative predictive values (NPV), and Pearson's correlation coefficient were used in the evaluation of the percentage of stenosis results. Homogeneity chi2 test was applied when assessing statistical significance. Severe stenosis was diagnosed in 34 ICAs. Two ICAs with uninterpretable CTA finding were excluded. The number of ICAs with stenoses 70-99%/<70%- US 32/0; CTA 29/3; US + CTA 29/3; DSA 24/8. Pearson's correlation coefficient - US 0.601; CTA 0.725; US + CTA 0.773. Sensitivity/specificity/PPV/NPV - US 1.0/0.75/0.75/xxx; CTA 1.0/0.844/0.828/1.0; US + CTA 1.0/0.844/0.828/1.0. Homogeneity chi2 test results - US, P = 0.002; CTA, P = 0.098; US + CTAG, P = 0.098. US in combination with CTA can be used for relatively secure diagnostics of severe ICA stenoses. Thus, invasive DSA can be avoided in a substantial number of patients.

Accuracy of gadoteridol enhanced MR-angiography in the evaluation of carotid artery stenosis

“…In addition, digital subtraction angiography was not available for comparison in our series, since just a minority of patients with clinically significant stenosis underwent stenting procedures while the others were treated with endarterectomy without angiography. However, it should be noted that CTA has been shown to be a valid alternative to DSA as reference standard in comparative studies and, in daily clinical practice, it is currently used as the modality of choice for carotid imaging [27,28]. Another relevant limitation is represented by the inter-individual design of the study; however, this was due to ethical reasons since patients with significant disease are referred for treatment rather than a second contrast-enhanced MRA exam.…”

Doppler-Ultrasound and computed tomography correlation for quantification of carotid stenosis

“…Moreover, it has been shown that peak systolic velocity (PSV) in the internal carotid artery is the best single velocity parameter for quantifying stenosis [9,10] . Alternatively, CTA may be used in the assessment of carotid artery stenosis [11,12] . CTA also has high diagnostic accuracy for ICA disease with sensitivity and specificity as high as 85% and 93%, respectively, for detection of significant carotid stenoses [13,14] .…”

Carotid atherosclerotic plaque characterisation by measurement of ultrasound sound speed in vitro at high frequency, 20MHz

“…The vessel will dilate in order to accommodate the plaque without narrowing the lumen (Glagov et al 1987 (Herzig et al 2004). This is beneficial to the patient as their radiation dose is decreased.…”