Why the study?
The diagnostic agreement between the revised multiparametric DEGUM ultrasonography approach and the established SRU consensus criteria for grading carotid artery disease was undetermined.
Does the DEGUM ultrasonography approach improve diagnostic accuracy compared to the SRU criteria for grading carotid artery disease?
Does the DEGUM ultrasonography approach improve diagnostic accuracy compared to the SRU criteria for grading carotid artery disease?
The revised multiparametric DEGUM ultrasonography approach is more specific than the SRU criteria for identifying severe carotid artery stenosis, reducing false-positive identifications.
DEGUM criteria may reduce false-positive severe carotid stenosis calls versus SRU; leaves open whether multiparametric approaches alter confirmatory testing rates.
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.
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Winzer et al. (2021) studied this question.
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