Detection of carotid bifurcation disease: Comparison of ultrasound tests with angiography

Abstract

Doppler-shift ultrasound with spectral analysis permits the measurement of the relative heights of systolic peaks (the A/B ratio) in blood velocity sonograms from supra-orbital and common carotid arteries, the temporal artery occlusion test, the common carotid resistance index and transit times of flow-velocity waves in the internal carotid pathway. The results are compared with 201 carotid angiograms and expressed in terms of sensitivity (true positive) and specificity (true negative). Supra-orbital and common carotid A/B ratios, in combination with the temporal artery occlusion test, detected all grades of carotid artery disease with a sensitivity of 72 per cent and a specificity of 93 per cent. The corrected transit time gave a sensitivity of 57 per cent and a specificity of 89 per cent, whilst the Resistance Index gave a sensitivity of 60 per cent and a specificity of 80 per cent. The values of ultrasound parameters associated with severe disease, defined as reductions in lumen diameter of 75 per cent or more, of the internal carotid artery are examined. The temporal artery occlusion test gave a sensitivity of 91 per cent and a specificity of 94 per cent. These results were more accurate than those obtained for the corrected transit time (sensitivity 83 per cent, specificity 92 per cent) and for the Resistance Index (sensitivity 75 per cent and specificity 92 per cent). The results show that of the tests described the supra-orbital and common carotid artery A/B ratios, together with the temporal artery occlusion test, gave the best sensitivity and specificity for detection of both severe and minor carotid bifurcation disease.

Fluid Resuscitation in Septic Patients Improves Systolic but not Diastolic Middle Cerebral Artery Flow Velocity

“…Characteristics of this systolic part are the steep increase just after stroke onset, acceleration (acc), and two systolic peaks (sys1 and sys2). Sys1 and sys2 correspond to the A and B peak originally encountered in extracranial circulation (Baskett et al 1977;Padayachee et al 1982). This alternative set of parameters has theoretical and practical benefits but also, for instance, excellent discriminative power in a group of patients with ipsilateral carotid artery stenosis in comparison with normal controls (Schaafsma 2012).…”

Doppler ultrasound assessment of the internal carotid artery following carotid endarterectomy.

“…16 ' 18 In a retrospective comparison between angiography and ultrasound in 201 carotid bifurcations it was shown that a combination of the TAOT and A/B ratio detected lesions in the internal carotid artery, of 25% and over reduction in lumen diameter, with a sensitivity of 92% and a specificity of 82%. 16 The purpose of this paper is to report our experience using this method to assess the patency of the internal carotid artery in patients following carotid endarterectomy.…”

“…13,14 The method used in this paper for assessing the carotid arteries, using spectral analysis of Dopplershifted ultrasound, has been reported previously. 15,16 The method is based on two parameters, that is, the temporal artery occlusion test (TAOT) 17 and the ratio of the two peaks (A and B) that occur during cardiac systole in sonagrams from the supraorbital and com mon carotid arteries ( fig. I).…”