Carotid Duplex Velocity Criteria Recommended by the Society of Radiologists in Ultrasound and Endorsed by the Intersocietal Accreditation Commission Lack Predictive Ability for Identifying High-Grade Carotid Artery Stenosis

Arous, Edward J.; Judelson, Dejah R.; Malka, Kimberly T.; Wyman, Allison; Simons, Jessica P.; Aiello, Francesco; Arous, Elias J.; Schanzer, Andres

doi:10.1016/j.avsg.2019.05.051

Cited by 13 publications

(7 citation statements)

References 15 publications

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“…Although the latter does not reflect the gold standard, the diagnostic accuracy of noninvasive imaging has improved significantly bringing these modalities increasingly into the focus of validation studies [20,21]. While this study demonstrated a poor predictive ability of SRU criteria for the identification of severe carotid artery stenosis, increasing the thresholds for peak systolic and end-diastolic velocities improved its predictive values remarkably [6].…”

Section: Discussionmentioning

confidence: 73%

“…Original data on PSV thresholds used for the SRU approach date back to the early 1990 s when no alternative noninvasive imaging was worth considering for validation studies [19]. A recent retrospective study evaluated the SRU ultrasonography criteria for diagnosis of ≥ 70 % carotid stenosis using computed tomography angiography as the reference test [6]. Although the latter does not reflect the gold standard, the diagnostic accuracy of noninvasive imaging has improved significantly bringing these modalities increasingly into the focus of validation studies [20,21].…”

Section: Discussionmentioning

confidence: 99%

“…Although endorsed by the Intersocietal Accreditation Commission, hemodynamic SRU criteria may be outdated and their overall diagnostic accuracy for the identification of clinically relevant stenosis categories is limited [5]. Moreover, a recent validation study indicated a low predictive value of the SRU hemodynamic criteria particularly with respect to identifying severe (i. e., ≥ 70 %) ICA stenosis as compared with CT angiography [6].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Ultrasonography Grading of Internal Carotid Artery Disease: Multiparametric German Society of Ultrasound in Medicine (DEGUM) versus Society of Radiologists in Ultrasound (SRU) Consensus Criteria

et al. 2021

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Purpose We sought to determine the diagnostic agreement between the revised ultrasonography approach by the German Society of Ultrasound in Medicine (DEGUM) and the established Society of Radiologists in Ultrasound (SRU) consensus criteria for the grading of carotid artery disease. Materials and Methods Post-hoc analysis of a prospective multicenter study, in which patients underwent ultrasonography and digital subtraction angiography (DSA) of carotid arteries for validation of the DEGUM approach. According to DEGUM and SRU ultrasonography criteria, carotid arteries were independently categorized into clinically relevant NASCET strata (normal, mild [1–49 %], moderate [50–69 %], severe [70–99 %], occlusion). On DSA, carotid artery findings according to NASCET were considered the reference standard. Results We analyzed 158 ultrasonography and DSA carotid artery pairs. There was substantial agreement between both ultrasonography approaches for severe (κw 0.76, CI95 %: 0.66–0.86), but only fair agreement for moderate (κw 0.38, CI95 %: 0.19–0.58) disease categories. Compared with DSA, both ultrasonography approaches were of equal sensitivity (79.7 % versus 79.7 %; p = 1.0) regarding the identification of severe stenosis, yet the DEGUM approach was more specific than the SRU approach (70.2 % versus 56.4 %, p = 0.0002). There was equality of accuracy parameters (p > 0.05) among both ultrasonography approaches for the other ranges of carotid artery disease. Conclusion While the sensitivity was equivalent, false-positive identification of severe carotid artery stenosis appears to be more frequent when using the SRU ultrasonography approach than the revised multiparametric DEGUM approach.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Ultrasonography Grading of Internal Carotid Artery Disease: Multiparametric German Society of Ultrasound in Medicine (DEGUM) versus Society of Radiologists in Ultrasound (SRU) Consensus Criteria

et al. 2021

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“…There are several different published criteria for classifying carotid stenosis based on flow velocities, and the Society of Radiologists in Ultrasound (SRU) consensus statement is one of the more widely accepted among them. 23 According to the SRU criteria, ICA stenosis of more than 70% is considered hemodynamically significant, with the highest PSV greater than 230 cm/s, end-diastolic velocity greater than 100 cm/s, and an ICA to CCA velocity ratio greater than 4.0. 24 With a stenosis of 50% to 69%, the highest PSV in the ICA is greater than 125 cm/s but less than 230 cm/s.…”

Section: Discussionmentioning

confidence: 99%

Doppler Study of the Left Common Carotid Artery With Preocclusive Stenosis

Bacha

Gilani

Manzoor

2022

Journal for Vascular Ultrasound

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Preocclusive stenosis of the common carotid artery is a rare and potentially life-threatening entity, and the early recognition of associated internal and external carotid artery patency is important for the management plan. The patient in this case report was sent for a thyroid ultrasound for complaints of neck pain, voice change, and dysphagia, and a preocclusive stenosis of the left common carotid artery was found. Multiple collateral pathways had developed to supply blood flow to the left internal carotid artery, and there was retrograde flow in the external carotid artery and antegrade flow in the internal carotid artery. Collaterals from the left thyrocervical trunk were supplying the superior thyroid artery which supplied the external carotid artery and finally the internal carotid artery through the carotid bulb. Doppler ultrasound is valuable in the identification of preocclusive common carotid artery stenosis and mapping of collateral pathways.

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“…Another important factor that may reduce the overall accuracy of DUS with respect to the ow velocities may be the presence of contralateral carotid occlusion, leading to the unilateral DUS velocities rise associated with compensatory blood ow increase [42,43]. It has been suggested that the accuracy of non-invasive imaging for the evaluation of cervical carotid artery stenosis may be generally overestimated in the literature [44][45][46]. This is relevant to clinical practice as -following the methodology of some large trials [refs] -up to 40% CEAs may still be performed today based on isolated DUS measurements [47].…”

Section: Discussionmentioning

confidence: 99%

Imaging modality-dependent carotid stenosis severity variations against intravascular ultrasound as a reference: Carotid Artery intravasculaR Ultrasound Study (CARUS)

Tekieli

Kabłak‐Ziembicka

Dąbrowski

et al. 2022

Preprint

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Purpose Different non-invasive and invasive imaging modalities are used to determine carotid artery stenosis severity as a principal parameter in clinical decision-making. We compared stenosis degree obtained with different modalities against intravascular ultrasound (IVUS). Methods 300 consecutive patients (age 47–83 years, 192 men, 68% symptomatic) with carotid artery stenosis of “≥50%” referred for potential revascularization received as per study protocol (i) duplex ultrasound (DUS), (ii) computed tomography angiography (CTA), (iii) invasive quantitative angiography (iQA) and (iv) the vascular imaging gold standard, IVUS. Correlation of measurements with IVUS (r), proportion of those concordant (within 10%) and proportion of under/overestimated were calculated along with recipient-operating-characteristics (ROC). Results For IVUS area stenosis (AS) and IVUS minimal lumen area (MLA), there was only a moderate correlation with DUS velocities (peak-systolic, PSV; end-diastolic, EDV; r values of 0.42–0.51, p < 0.001 for all). CTA systematically underestimated both reference area and MLA (80.4% and 92.3% cases) but CTA error was lesser for AS (proportion concordant-57.4%; CTA under/overestimation 12.5%/30.1%). iQA diameter stenosis (DS) was found concordant with IVUS in 41.1% measurements (iQA under/overestimation 7.9%/51.0%). By univariate model, PSV (ROC area-under-the-curve, AUC, 0.77, cutoff 2.6m/s), EDV (AUC 0.72, cutoff 0.71m/s) and CTA-DS (AUC 0.83, cutoff 59.6%) were predictors of ≥ 50% DS by IVUS (p < 0.001 for all). Best predictor, however, of ≥ 50% DS by IVUS was iQA densitometry (AUC 0.87, cutoff 68%, p < 0.001). On multivariate model, however, CTA came as the sole independent non-invasive diagnostic modality (p = 0.008). Conclusion IVUS validation shows significant imaging modality-dependent variations in carotid stenosis severity determination.

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Carotid Duplex Velocity Criteria Recommended by the Society of Radiologists in Ultrasound and Endorsed by the Intersocietal Accreditation Commission Lack Predictive Ability for Identifying High-Grade Carotid Artery Stenosis

Cited by 13 publications

References 15 publications

Ultrasonography Grading of Internal Carotid Artery Disease: Multiparametric German Society of Ultrasound in Medicine (DEGUM) versus Society of Radiologists in Ultrasound (SRU) Consensus Criteria

Ultrasonography Grading of Internal Carotid Artery Disease: Multiparametric German Society of Ultrasound in Medicine (DEGUM) versus Society of Radiologists in Ultrasound (SRU) Consensus Criteria

Doppler Study of the Left Common Carotid Artery With Preocclusive Stenosis

Imaging modality-dependent carotid stenosis severity variations against intravascular ultrasound as a reference: Carotid Artery intravasculaR Ultrasound Study (CARUS)

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