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

Abstract

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.

Ultrasound assessment of brain supplying arteries (extracranial)

“…A direct comparison of the DEGUM multiparametric graduation criteria with the SRU graduation criteria versus DSA as the “gold standard” showed a significant reduction of incorrect classifications into the category of ICA stenoses ≥ 70 % when the DEGUM criteria were used (specificity of DEGUM criteria 70.2 % versus specificity of SRU criteria 56.4 %). However, the overall accuracy did not differ significantly (85.4 % versus 84.8 % for ICA stenosis ≥ 50 % and 74.1 % versus 65.8 % for ICA stenosis ≥ 70 %) 21 .…”

“…Die Gesamtgenauigkeit unterschied sich allerdings nicht signifikant (85,4 % versus 84,8 % für eine ACI-Stenose ≥ 50 % bzw. 74,1 % versus 65,8 % für eine ACI-Stenose ≥ 70 %) 21 .…”

Ophthalmic artery reversal predicts contralateral body weakness symptoms better than carotid Doppler velocity—preliminary results

“…The merit of a diagnostic test is often represented by sensitivity and specificity displayed as a receiver operator characteristic (ROC) curve for various criterion threshold values. Figure 5 ( 9 , 11 - 13 ) compares the ROC for PSV with the values for OAr and bruit using the symptom of contralateral facial droop or body weakness indicating transient ischemic attack (TIA) or stroke as the reference standard rather than a %DR angiographic stenosis.…”

“…The 95% CI on each proportion is indicated by the blue field surrounding the point ( 9 ). For reference, a purple diamond with rust outline shows the DEGUM ( 11 - 13 ) values for ultrasound PSV >400 cm/s and collateral and “confetti sign” vs. >70%DR by DSA ( 11 - 13 ) with the 95% CI in pink. ROC, receiver operator characteristic; PSV, peak systolic velocity; OA, ophthalmic artery; OAr, OA reversal; Br, bruit; DEGUM, German Society of Ultrasound in Medicine; ICA, internal carotid artery; %DR, percent diameter reduction; DSA, digital subtraction angiography; CI, confidence interval.…”

Development and Validation of Machine Learning Models to Classify Artery Stenosis for Automated Generating Ultrasound Report

“…Several guidelines and diagnostic criteria are used to interpret and report a complete TCD and ECCD examination. These guidelines and criteria mentioned that DUS examination reports should be performed in grayscale images, spectral Doppler waveforms, spectral Doppler velocities, and color Doppler images [ 10 , 11 , 12 ]. The European Stroke Organization and the American Society of Neuroimaging Practice Guidelines recommended several high-velocity criteria for detecting, quantifying, and progressing CAS [ 13 , 14 ].…”