Variability in Measurement of Extracranial Internal Carotid Artery Stenosis as Displayed by Both Digital Subtraction and Magnetic Resonance Angiography

Young, Gavin; Humphrey, P. R. D.; Nixon, T.; Smith, Elizabeth

doi:10.1161/01.str.27.3.467

Cited by 42 publications

(27 citation statements)

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“…Recently, different measuring methods have been compared on angiograms. [3][4][5][6]27,28 Vanninen and colleagues compared ECST and NASCET methods and found the greatest interobserver variability with NASCET measurements. 27 Their findings are in agreement with those of Bladin and associates who also found NASCET to be the least reproducible method.…”

Section: Discussionmentioning

confidence: 99%

“…6,28 Rothwell and coworkers, Eliasziw and associates, and Young and colleagues compared reproducibility of ECST, NASCET, and CC methods. [3][4][5] Rothwell and coworkers recommended the CC method, because it showed the best reproducibility, particularly for lumen reduction in the clinically important range of 50 to 90%. Conversely, Eliasziw and associates and Young and colleagues reported no consistent differences between the measuring methods.…”

Section: Discussionmentioning

confidence: 99%

“…This method relates the minimal lumen diameter to the diameter of the distal CCA. [3][4][5][6] With the risk of stroke or death for selective angiography ranging from 1 to 4% in patients with atherosclerosis, 7,8 continuous efforts have been directed toward the design of an optimal diagnostic strategy with less invasive methods for patient selection. [9][10][11] Ultrasonography and, more specifically, hemodynamic parameters obtained with pulsed Doppler sonography have been extensively studied for noninvasive quantification of ICA stenosis.…”

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confidence: 99%

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Lumen reduction measurements of the internal carotid artery before and after Levovist enhancement: reproducibility and agreement with angiography.

Elgersma

Leeuwen

Meijer

et al. 1999

Journal of Ultrasound in Medicine

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Our aim was to assess reproducibility of three different lumen reduction measuring methods‐‐North American Symptomatic Carotid Endarterectomy Trial, European Carotid Surgery Trial, and common carotid‐‐using power Doppler and color Doppler sonography before and after Levovist enhancement. We included 20 symptomatic patients with mild or severe carotid disease. North American Symptomatic Carotid Endarterectomy Trial, European Carotid Surgery Trial, and common carotid measurements on longitudinal views and European Carotid Surgery Trial measurements on transverse views were performed. Examinations were repeated and the results compared to assess reproducibility of measurements. Correlation with angiography was obtained by calculating Pearson correlation coefficients. Reproducibility was significantly better (P < 0.05) for European Carotid Surgery Trial and common carotid measurements (95% limits of agreement between ‐10% to 10% and ‐19% to 17%) as compared to North American Symptomatic Carotid Endarterectomy Trial measurements (95% limits of agreement between ‐11% to 21% and ‐21% to 23%). Variability of measurements after enhancement increased slightly (not significant) for both power and color Doppler sonography. Additionally, European Carotid Surgery Trial measurements, using nonenhanced power Doppler or color Doppler sonography, did not correlate significantly with angiography, whereas North American Symptomatic Carotid Endarterectomy Trial and common carotid measurements correlated well with angiography, particularly in power Doppler mode after enhancement (r = 0.88 and r = 0.82, respectively). We conclude that for lumen reduction measurements of the internal carotid artery with power and color Doppler sonography, the common carotid method is the only method that is reproducible and has good correlation with angiography, which slightly improves after Levovist enhancement.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Lumen reduction measurements of the internal carotid artery before and after Levovist enhancement: reproducibility and agreement with angiography.

Elgersma

Leeuwen

Meijer

et al. 1999

Journal of Ultrasound in Medicine

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“…14 Although it has been reported that duplex US findings can be even more precised than angiographic findings 15 , the experiences from the NASCET (North American Symptomatic Carotid Endarterectomy Trial) and the Committee for the Asymptomatic Carotid Atherostenosis provide the rationale for performing carotid artery surgery, evolved from stenosis diameter measurements on angiograms. Which shows that the diameter of a stenosis measured at angiography remains the reference standard.…”

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confidence: 99%

Cerebral Ischaemia and Stroke; Role of Carotid Doppler

Khan¹

2017

TPMJ

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ABSTRACT… Introduction: Colour Doppler sonography is a well-established widely available, noninvasive, cost effective and a reliable method for assessing cerebrovascular circulation. It has become a valuable completion of the sonographic workup in patients with cerebral ischaemia and infarction. Its accuracy is close to angiography. Objectives: To determine the frequency of significant carotid artery stenosis in patients of cerebral ischaemia/stroke and its characterized sonographic appearance of plaque. Study Design: Cross sectional study, based on nonprobability convenience sample technique. Setting: Department of Radiology, Combined Military Hospital Lahore, using Colour and Power Doppler Ultrasound machine ALOKA SSD-5500. Period: 14 October 2006 to 15 March 2007. Methodology: Total of 50 diagnosed patients of either gender, aged 30 to 70 years with cerebral ischaemia and stroke were included in the study. Carotid Doppler examination was conducted in each patient and findings were recorded. Results: Among 50 patients who underwent carotid Doppler examination for diagnosis of clinically significant carotid artery stenosis, 35 patients had carotid plaques. 08 patients were diagnosed to have more than 70 % stenosis, 07 patients with more than 50 % and 20 patients less than 50 % carotid artery stenosis. 15 patients did not show any carotid artery disease. 12 patients had bilateral stenosis while 23 had unilateral disease. Mean age of the patients with and without carotid artery disease was 52 ± 7.87 years. Conclusion: Majority of patients with Cerebral ischemia/stroke showed carotid artery stenosis on colour Doppler ultrasound. Common age group who developed cerebral ischemia/stroke was above 50years.

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“…16 -18 A population-based study using angiography would be unethical, and studies using Doppler or MR angiography would not allow such accurate measurements of all the bifurcation vessels. MR angiography is less accurate than arterial angiography, 19,20 and Doppler is often not able to image the internal carotid artery (ICA) distal to the bulb. 16,21 Thus, a large angiographybased study in a selected population would probably provide more reliable data on the extent of variation in carotid bifurcation anatomy than a smaller noninvasive, imagingbased study in the general population.…”

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confidence: 99%

Major Variation in Carotid Bifurcation Anatomy: A Possible Risk Factor for Plaque Development?

Schulz¹,

Rothwell²

2001

Stroke

135

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Background and Purpose-Why is carotid plaque often so strikingly asymmetrical within individuals, and why does the extent of disease vary so considerably between individuals with similar systemic risk factors? Variability of carotid bifurcation anatomy is a possible explanation. Flow models suggest that vessel anatomy, in particular vessel diameter and area ratios, affects plaque formation at arterial bifurcations. However, carotid bifurcation anatomy could only be a major risk factor for plaque formation if it was sufficiently variable. Since very few data exist on the extent of interindividual and intraindividual variability of bifurcation anatomy, we studied 5395 angiograms from the European Carotid Surgery Trial. Methods-To minimize changes in bifurcation anatomy secondary to atherosclerosis, we excluded vessels with Ն30% stenosis. We measured arterial diameters at disease-free points and calculated the following ratios: internal to common carotid (ICA/CCA), external to common carotid (ECA/CCA), external to internal carotid (ECA/ICA), and outflow/ inflow area. For intraindividual asymmetry, we compared the ratios on both sides. Results-Each ratio varied markedly between individuals. The 95% ranges were as follows: ICA/CCA, 0.44 to 0.86; ECA/CCA, 0.34 to 0.80; ECA/ICA, 0.55 to 1.33; and outflow/inflow area, 0.38 to 1.28. The results were very similar in 407 bifurcations with no disease. Among the 755 patients with Ͻ30% stenosis bilaterally, side differences of Ն25% were present in 17% (95% CI, 15% to 20%) for the ICA/CCA ratio, 27% (95% CI, 24% to 30%) for the ECA/CCA ratio, 32% (95% CI, 28% to 35%) for the ECA/ICA ratio, and 42% (95% CI, 38% to 45%) for the outflow/inflow area ratio. Conclusions-We found large interindividual differences in carotid bifurcation anatomy. For example, there was 4-fold variation of the ratio of outflow to inflow area. Intraindividual variation was also considerable. These data highlight the potential importance of anatomic variation as a risk factor for atheroma and provide a firm basis for flow modeling studies.

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Variability in Measurement of Extracranial Internal Carotid Artery Stenosis as Displayed by Both Digital Subtraction and Magnetic Resonance Angiography

Abstract: Although observer variability in reporting can be considerable, no important differences were found among the different techniques widely used for measuring carotid stenosis.

Cited by 42 publications

References 10 publications

Lumen reduction measurements of the internal carotid artery before and after Levovist enhancement: reproducibility and agreement with angiography.

Lumen reduction measurements of the internal carotid artery before and after Levovist enhancement: reproducibility and agreement with angiography.

Cerebral Ischaemia and Stroke; Role of Carotid Doppler

Major Variation in Carotid Bifurcation Anatomy: A Possible Risk Factor for Plaque Development?

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