Multicenter validation study of real-time (B-mode) ultrasound, arteriography, and pathologic examination

Abstract

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.

Detection of Carotid Artery Plaque Ulceration Using 3-Dimensional Ultrasound

“…The correlation between ultrasonography and histological evaluation of the atherosclerotic plaque is often poor. [26][27][28] This is mainly due to the fact that most correlation studies were performed more than 10 years ago, with the equipment of that time providing an image quality significantly inferior than that of the modern ultrasound scanners and in particular of the so-called compound imaging, which has been made possible through improvements in the computational power. 12 Another explanation for the poor correlation between ultrasound findings and histology is the fact that these studies are not done concurrently and that there is usually a very wide variability in the time interval between ultrasound examination and carotid endarterectomy.…”

High‐Resolution B‐Mode Ultrasound Reading Methods in the Atherosclerosis Risk in Communities (ARIC) Cohort

“…This permitted a more detailed study of earlier nonstenotic atherosclerotic changes in arterial walls, earlier than what could be assessed with angiography. In 1981, a multicenter validation study was initiated to compare ultrasound B-mode images with angiographic images of the carotid system and to compare both methods with pathology [6][7][8]. Results led to the conclusion that standardized protocols and quality control procedures were needed to reliably measure arterial wall thickness by ultrasound.…”

The Role of High-Sensitivity C-Reactive Protein in Asymptomatic Intra- and Extracranial Large Artery Diseases

“…Isolated nodular lesions or intima-media thicknesses of greater than 1.0 mm detected in these sites of the bilateral carotid arteries were defined as atherosclerosis. When any atherosclerotic lesion was seen in the carotid arteries, the maximum percentage of stenosis was calculated from the residual lumen diameter and distance from the original walls at the site of maximum lumen narrowing [19]. A 25% or greater reduction in arterial diameter was defined as extracranial carotid artery stenosis.…”