Validation of Multiparametric Ultrasonography Criteria with Digital Subtraction Angiography in Carotid Artery Disease: A Prospective Multicenter Study

Barlinn, Kristian; Rickmann, Henning; Kitzler, Hagen H.; Krogias, Christos; Strohm, Henning; Abramyuk, Andrij; Barlinn, Jessica; Siepmann, Timo; Rabahi, Ali; Graehlert, Xina; Schwanebeck, Uta; Winzer, Simon; Arnold, Sebastian; Moennings, Peter; Pallesen, Lars-Peder; Bodechtel, Ulf; Mudra, Harald; Linn, Jennifer; Reichmann, Heinz; Alexandrov, Andrei V.; Gahn, Georg; Weiss, Norbert; Puetz, Volker

doi:10.1055/s-0043-119355

Cited by 17 publications

(19 citation statements)

References 31 publications

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“…Contrary, in a multicentre study, Barlinn and colleagues reported only a moderate agreement and concluded that a confirmatory test is still needed for the grading of ICAS with CDS applying the multiparametric DEGUM ultrasound criteria [29]. In their Bland and Altman diagram, however, their agreement between CDS and DSA seemed to be better when only considering severe (≥ 70% NASCET) ICAS [29] like in our study. Fourthly, we did not assess parameters that are supposed to affect the haemodynamic effect of the ICAS like the blood viscosity (e.g.…”

Section: Discussioncontrasting

confidence: 96%

Evaluation of the interrater and intermethod agreement of the German multiparametric ultrasound criteria for the grading of internal carotid artery stenosis

et al. 2020

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Purpose The interdisciplinary German guidelines for the diagnosis and treatment of internal carotid artery stenosis (ICAS) recommend a multiparametric approach for the sonographic grading of extracranial ICAS. The aim of this study is to evaluate the interrater and intermethod agreement of this elaborated sonographic approach with different angiographic modalities. Methods Patients with extracranial ICAS were examined twice with colour-coded duplex sonography (CDS) by two experienced vascular neurologists. Each of the ten criteria and the resulting stenotic value were assessed. Grading of ICAS based on the multiparametric ultrasound criteria was compared with different angiography modalities (magnetic resonance angiography (MRA), computed tomography angiography (CTA), digital subtraction angiography (DSA)). Results Seventy-four consecutive patients with 91 extracranial ICAS were recruited from our stroke unit and neurovascular outpatient clinic. Interrater agreement for each single ultrasound criterion ranged from moderate to excellent (for the peak systolic velocity). Concerning the absolute stenotic value of ICAS, an excellent agreement between both ultrasound examiners with an ICC of 0.91 (range 0.87–0.94; p < 0.001) was found. In 96% of ICAS, the difference between the stenotic values was ≤ 10%. Intermethod agreements between CDS and DSA, CTA, and MRA were also good for both sonographers. Conclusion Strictly adhering to the multiparametric “DEGUM ultrasound criteria”, we found an excellent interrater agreement and a good intermethod agreement compared with angiography for the sonographic grading of extracranial ICAS. Thus, multiparametric CDS is in particular suitable for the follow up of extracranial ICAS even when examinations are done by different sonographers.

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Section: Discussioncontrasting

confidence: 96%

Evaluation of the interrater and intermethod agreement of the German multiparametric ultrasound criteria for the grading of internal carotid artery stenosis

et al. 2020

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“…Indeed, results regarding a subset of 10 carotid occlusions in our study were somewhat less than perfect [1]. Nevertheless, given the fact that the revised DEGUM approach does not provide specific criteria for differentiating between total and near carotid occlusion [2], its low positive predictive value and sensitivity compared to invasive angiography is not surprising, aside from the low number of occlusions.…”

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confidence: 54%

“…We thank Prof. von Reutern for commenting on our article on the prospective multicenter validation of the revised DEGUM ultrasound criteria for carotid artery stenosis grading [1,2]. We would like to emphasize that our study was not meant to evaluate the ultrasound modality per se, but rather the revised and widely used multiparametric DEGUM approach for ultrasound grading of carotid artery disease as many other approaches have been validated before [3].…”

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confidence: 99%

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Authors’ Response to Letter: Validation of Multiparametric Ultrasonography Criteria with Digital Subtraction Angiography in Carotid Artery Disease: A Prospective Multicenter Study

et al. 2019

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“…Doppler ultrasonography is a tool combined with B-mode ultrasonography that allows the hemodynamic evaluation of the vessels (Loizou 2014, Barlinn et al 2018, Boyko et al 2018, Mckenna et al 2018, Oglat et al 2018. The common carotid artery originates three important arteries in horses and mules: the internal carotid artery, the external carotid artery and the occipital artery.…”

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confidence: 99%

Comparison of right and left common carotid arteries of horses and mules by two-dimensional ultrasound and Doppler flow

et al. 2020

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In ultrasonography, the bi-dimensional mode (B-mode) allows the morphological and morphometric evaluation of several types of organs and tissues, while the Doppler mode allows the hemodynamic evaluation. In humans, the Doppler evaluation is routinely used in the assessment of important arteries and veins, such as the carotid arteries and jugular veins, with significant differences between genres and sides. However, in veterinary medicine, this diagnostic method is not yet well established in the evaluation of the carotid arteries, with only few reports in domestic horses. This study aims to compare the right and left common carotid arteries of domestic horses and mules using bi-dimensional and Doppler ultrasound evaluation. The common carotid arteries from 10 domestic horses (five males and five females) and 10 mules (five males and five females) were evaluated. The following variables were measured at three different portions (cranial, middle and caudal): diameter, intima-media thickness (IMT), resistivity index (RI), pulsatility index (PI), peak of systolic velocity (pSV) and final diastolic velocity (fDV). No significant differences were observed in the bi-dimensional variables (diameter and IMT) between the common carotid arteries of horses and mules, regardless of gender (p>0.05). In Doppler mode, there were no significant differences between carotid values in male and female horses (p> 0.05). In the mules, it was only possible to observe differences between the RI and PI values (p<0.05), being higher on the left side (0.81 and 2.04 respectively), and the fDV (p<0.05) higher, on the right side (14.35) in males. As for females, there was only in fDV (p<0.05), with the upper right side (23.16). Diameters and IMT do not differ between sides in horses and mules in B-mode ultrasound. Spectral Doppler in horses does not differ between sides, regardless of gender. As for mules, males differ in RI, PI and fDV between sides, while females differ only in fDV.

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Validation of Multiparametric Ultrasonography Criteria with Digital Subtraction Angiography in Carotid Artery Disease: A Prospective Multicenter Study

Abstract: At laboratories experienced with ultrasound grading of the extracranial ICA, the revised DEGUM multiparametric ultrasonography criteria do not eliminate the need for a confirmatory test for the identification of clinically relevant grades of the disease.

Cited by 17 publications

References 31 publications

Evaluation of the interrater and intermethod agreement of the German multiparametric ultrasound criteria for the grading of internal carotid artery stenosis

Evaluation of the interrater and intermethod agreement of the German multiparametric ultrasound criteria for the grading of internal carotid artery stenosis

Authors’ Response to Letter: Validation of Multiparametric Ultrasonography Criteria with Digital Subtraction Angiography in Carotid Artery Disease: A Prospective Multicenter Study

Comparison of right and left common carotid arteries of horses and mules by two-dimensional ultrasound and Doppler flow

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