Abstract
Clinicians have relied on published institutional experience for interpreting carotid duplex ultrasound studies. We conducted a study where we analyzed 376 carotid arteries to validate the ultrasound imaging consensus criteria published in 2003. We used receiver operating curves (ROC) to compare peak systolic velocities (PSV), end-diastolic velocities (EDV) of the internal carotid artery (ICA), and ICA/common carotid ratios in detecting <50%, 50–69% (ICA PSV of 125–230 cm/s), and 70–99% (PSV of ≥230 cm/s) stenosis according to the consensus criteria. The consensus criteria uses a PSV of 125–230 cm/s for detecting angiographic stenosis of 50–69%, which had a sensitivity of 93%, specificity of 68%, and overall accuracy of 85%. A PSV of ≥230 cm/s for ≥70% stenosis had a sensitivity of 99%, specificity of 86%, and overall accuracy of 95%. ROC curves showed that the ICA PSV was significantly better than EDV or ICA/CCA ratio (p = 0.036) in detecting ≥70% stenosis and ≥50% stenosis. The consensus criteria for diagnosing 50–69% stenosis can be significantly improved by using an ICA PSV of 140–230 cm/s, with a sensitivity of 94%, a specificity of 92%, and an overall accuracy of 92%. We concluded that the consensus criteria can be accurately used for diagnosing ≥70% stenosis; however, the accuracy can be improved for detecting 50–69% stenosis if the ICA PSV is changed to 140 to <230 cm/s.
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Review Questions
Review Questions
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1.
The original carotid duplex consensus criteria recommended the following velocities for detecting ≥70 to 99% internal carotid artery stenosis:
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a.
An internal carotid artery PSV of ≥230 cm/s
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b.
An internal carotid artery PSV of ≥200 cm/s
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c.
An internal carotid artery PSV of ≥150 cm/s
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d.
An internal carotid artery PSV of ≥300 cm/s
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a.
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The original carotid duplex consensus criteria recommended that a PSV of ≥230 cm/s preferably be combined with the following:
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a.
An internal carotid artery EDV of ≥70 cm/s
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b.
An internal carotid artery EDV of >100 cm/s
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c.
An internal carotid artery EDV of ≥140 cm/s
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d.
An internal carotid artery EDV of ≥150 cm/s
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a.
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3.
The carotid duplex consensus criteria recommended the following ratios to be combined with a PSV of >230 cm/s, if needed:
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a.
ICA/CCA ratio of >2
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b.
ICA/CCA ratio of >3
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c.
ICA/CCA ratio of >4
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d.
ICA/CCA ratio of >5
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a.
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4.
This carotid duplex consensus criteria validation study showed the following:
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a.
A PSV of the internal carotid artery of ≥230 cm/s was the best predictor of ≥70 to 99% stenosis.
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b.
A PSV of the internal carotid artery of >140 to <230 cm/s was a better predictor for detecting 50 to <70% stenosis.
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c.
A PSV of the internal carotid artery of >230 cm/s was a better predictor than the EDV of 100 or a ratio of >4.
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d.
All of the above.
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a.
Answer Key
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c
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d
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AbuRahma, A.F. (2017). Carotid Duplex Consensus Criteria on Interpretation of Carotid Duplex Ultrasound. In: AbuRahma, A. (eds) Noninvasive Vascular Diagnosis. Springer, Cham. https://doi.org/10.1007/978-3-319-54760-2_19
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DOI: https://doi.org/10.1007/978-3-319-54760-2_19
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