Key result
Modern carotid IMT measurements lack comparability to historical nomograms, limiting clinical utility for CVD risk.
Why the study?
Technological advances in ultrasound imaging alter image generation, raising questions about whether modern carotid IMT measurements remain comparable to historical population nomograms used to determine atherosclerotic cardiovascular disease risk.
Technological advances in ultrasound imaging have rendered modern carotid IMT measurements incompatible with historical reference nomograms, limiting their current clinical utility for cardiovascular risk assessment.
Clinicians should avoid historical nomograms for modern carotid IMT; leaves open the need for updated reference standards in research.
In this review, we describe how technological advances in ultrasound imaging related to transducer construction and image processing fundamentally alter generation of ultrasound images to produce better quality images with higher resolution. However, carotid intima-media thickness (IMT) measurements made from images acquired on modern ultrasound systems are not comparable to historical population nomograms that were used to determine wall thickness thresholds that inform atherosclerotic cardiovascular disease risk. Because it is nearly impossible to replicate instrumentation settings that were used to create the reference carotid IMT nomograms and to place an individual's carotid IMT value in or above a clinically relevant percentile, carotid IMT measurements have a very limited role in clinical medicine, but remain a useful research tool when instrumentation, presets, image acquisition, and measurements can be standardized. In addition to new validation studies, it would be useful for the ultrasound imaging community to reach a consensus regarding technical aspects of ultrasound imaging acquisition, processing, and display for blood vessels so standard presets and imaging approaches could reliably yield the same measurements.
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Mitchell et al. (2020) conducted a review in Atherosclerotic cardiovascular disease. Modern ultrasound systems vs. Historical ultrasound systems was evaluated on Carotid intima-media thickness (IMT) measurements. Modern ultrasound measurements of carotid intima-media thickness are not comparable to historical population nomograms, limiting their clinical utility for assessing cardiovascular disease risk.
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