Key result
Power Doppler ultrasonography underestimated ICA stenosis compared to digital subtraction angiography (mean difference -5; 95% CI -8 to -3), but a 45% threshold yielded 95% sensitivity.
Why the study?
Does Power Doppler ultrasonography accurately detect asymptomatic 60-99% internal carotid artery stenosis compared to digital subtraction angiography?
Cross-Sectional (n=95)
Does Power Doppler ultrasonography accurately detect asymptomatic 60-99% internal carotid artery stenosis compared to digital subtraction angiography?
Power Doppler ultrasonography is a rapid and sufficiently accurate screening tool for asymptomatic carotid artery stenosis when a lower diagnostic threshold (45%) is applied to account for its tendency to underestimate stenosis severity.
May support adjusted-threshold Power Doppler for ICA stenosis screening; leaves open prospective validation versus angiography.
We investigated the accuracy and efficacy of power Doppler ultrasonography (PDU) as a screening test in asymptomatic 60–99 % internal carotid artery (ICA) stenosis. 95 patients with internal carotid artery stenosis were examined with PDU prior to digital subtraction angiography (DSA). The results of PDU were compared with those of DSA as a reference standard. The average examination time of both carotid arteries using PDU was 3.25±1.25 minutes. The results of PDU and DSA showed a good correlation (r=0.79, p<0.001). PDU significantly underestimated ICA stenosis. The average difference between the results of PDU and DSA was −5 (95% CI: −8, −3). This underestimation was more marked at the level of 50–99 % angiographic stenosis. In determining 60–99% ICA stenosis, the sensitivity of PDU was 59% and its specificity was 97%. By taking into consideration PDU's underestimation, a PDU measurement of 45% was determined as the new threshold with high sensitivity which is suitable for purposes of screening. For this threshold, the sensitivity was found to be 95% and specificity 82%. The agreement between the observers in determining ICA stenosis by PDU was found to be fair to good (κ=0.48). PDU underestimates ICA stenosis, but this underestimation can be counterbalanced by taking a lower threshold. PDU is a rapid and easily performed method which has sufficient accuracy as a screening test in determining ICA stenosis.
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Yurdakul et al. (2005) conducted a cross-sectional in Asymptomatic internal carotid artery stenosis (n=95). Power Doppler ultrasonography (PDU) vs. Digital subtraction angiography (DSA) was evaluated on Difference in stenosis measurement between PDU and DSA (MD -5, 95% CI -8 to -3). Power Doppler ultrasonography underestimated ICA stenosis compared to digital subtraction angiography (mean difference -5; 95% CI -8 to -3), but a 45% threshold yielded 95% sensitivity.
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