Can continuous-wave Doppler ultrasound accurately quantify the degree of carotid stenosis compared to x-ray angiography?
Continuous-wave Doppler ultrasound can detect significant carotid stenosis based on peak systolic frequencies, though correlation with angiography is limited by the inherent inaccuracies of 2D x-ray projections.
Two methods for determining the degree of stenoses developing on the origin of the internal carotid were tested using non-invasive Doppler ultrasonic imaging (DOPSCAN) of the carotid bifurcations. Spectral analysis of Doppler audio recordings was utilized in determining the maximum frequencies found within the stenosis, as well as the ratio of the frequency downstream to the stenosis, to the frequency within the stenosis. The theoretical relationships between blood flow, velocity, and pressure drop are defined for all grades of stenosis and they predict that carotid flow will not be reduced unless the lumen diameter is less than 1.5 mm. At critical diameter reductions, below 1 mm, the frequencies in human carotids do not exceed 16 KHz because turbulence limits peak velocities. If the maximum systolic frequency exceeds 5 KHZ, when 5 MHZ probes are directed at a 30 degree angle from the body axis, there is always present stenosis up to diameters of less than 3.5 mm by x-ray angiographic measurements. Frequency ratio studies confirm that plaque growth is not symmetrical but they did not improve x-ray angiography correlations because of the limitations of x-ray in measuring cross sectional areas from projection films and limitations of the spot size of x-ray tubes.
Spencer et al. (1979) studied this question.