Color Doppler, power Doppler and B-flow ultrasound in the assessment of ICA stenosis: Comparison with 64-MD-CT angiography

Abstract

The purpose of this study is to investigate the diagnostic potential of color-coded Doppler sonography (CCDS), power-Doppler (PD) and B-flow ultrasound in assessing the degree of extracranial internal carotid artery (ICA) stenosis in comparison to CT-angiography (MD-CTA). Thirty-two consecutive patients referred for CTA with 41 ICA-stenoses were included in this prospective study. MD-CTA was performed using a 64 row scanner with a CTDIvol of 13.1 mGy/cm. In CTA, CCDS, PD and B-flow, the degree of stenosis was evaluated by the minimal intrastenotic diameter in comparison to the poststenotic diameter. Two radiologists performed a quantitative evaluation of the stenoses in consensus blinded to the results of ultrasound. These were correlated to CTA, CCDS, PD and B-flow, intraoperative findings and clinical follow-up. Grading of the stenoses in B-flow ultrasound outperformed the other techniques in terms of accuracy with a correlation coefficient to CTA of 0.88, while PD and CCDS measurements yield coefficients of 0.74 and 0.70. Bland-Altman analysis additionally shows a very little bias of the three US methods between 0.5 and 3.2 %. There is excellent correlation (coefficient 0.88, CI 0.77-0.93) with 64-MD-CTA and B-flow ultrasound in terms of accuracy for intrastenotic and poststenotic diameter. Duplex sonography is useful for screening purposes.

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease

“…Rapid image acquisition and processing, continuous image acquisition ("spiral CT"), and multiple-detector systems have made highresolution CTA clinically practical. [193][194][195][196][197][198][199] Like MRA, CTA provides anatomic imaging from the aortic arch through the circle of Willis. Multiplanar reconstruction and analysis allows evaluation of even very tortuous vessels.…”

Measurement of Carotid Stenosis Using Duplex Ultrasonography with a Microconvex Array Transducer: A Validation with Cerebral Angiography

“…Clevert et al reported that Bflow, which is quite similar technology to the EFI utilized in the present study, provided better ultrasonographic diagnosis of ICA stenosis as compared with color Doppler flow imaging and power Doppler imaging as a result of negligible pulsation and blooming artifacts. 26 Some studies have demonstrated a good correlation between the NASCET measurement by B-flow and by DSA. 27,28 Similar to B-flow, EFI is able to visualize blood flow with improved spatial and temporal resolution by applying a composite pulse emission technique.…”

Contrast-enhanced magnetic resonance angiography in carotid artery disease: does automated image registration improve image quality?

“…However, catheter-based DSA bears the risk of complications due to its invasiveness, specifically the risk of stroke. Noninvasive diagnostic alternatives include duplex ultrasonography, CTA and MRA [5,19]. ANOVA (analysis of variance) of the three image quality parameters with the two independent factors "image registration method" and "body shift class" revealed no statistically significant results at p<0.05, i.e.…”

“…A comparison of registration methods is given in Fig. 1 VDP vessel detection probability, CNR-MIP contrast-to-noise ratio in MIP images, CNR-3D contrast-to-noise ratio in 3D subtraction image volumes a All F ratios (variance ratios) are based on the residual mean square error Duplex ultrasonography is being used as a screening method, whereas CTA and MRA provide images of the entire cervical arterial tree that may be referred to during surgical or neuroendovascular intervention [7,19,20]. For the detection of severe 70-99% carotid artery stenosis according to the NASCETcriteria, a recent meta-analysis found contrastenhanced MRA to be more sensitive and specific than CTA or duplex ultrasonography (respective sensitivities of 94%, 76% and 89% with specificities of 93%, 94% and 84%) [7].…”