Direct B-mode NASCET-style stenosis measurement combined with Doppler parameters achieved 100% sensitivity for detecting >50% and >80% internal carotid artery stenosis.
Observational
Does direct B-mode NASCET-style stenosis measurement accurately assess internal carotid artery stenosis compared to digital subtraction angiography?
Direct B-mode NASCET-style stenosis measurement is highly accurate for assessing ICA stenosis and can be used as an initial screening tool to optimize ultrasound resources.
Doppler ultrasound grading of internal carotid artery (ICA) stenosis using the two parameters of spectral analysis and internal carotid to common carotid artery peak systolic velocity (ICA/CCA PSV) ratio is well established. The improvements in B-Mode ultrasound image quality now make direct ultrasound NASCET-style stenosis measurement possible. We demonstrate that longitudinal B-mode imaging can produce accurate North American Symptomatic Carotid Endarterectomy Trial (NASCET) style measurements which have good correlation with angiographic images. Ultrasound B-mode stenosis measurement provides a third parameter which can be used in conjunction with the two Doppler parameters for the assessment of ICA stenosis. Taking the highest grade of stenosis of the three parameters produces a sensitivity of 100% for the detection of greater than 50% and greater than 80% stenosis with specificity of 66 and 90%, respectively. The performance of satisfactory B-mode imaging against digital subtraction angiography (DSA) was very encouraging. When the B-mode stenosis measurement showed a normal ICA, the positive predictive value (PPV) of the DSA being normal was 94%. When the B-mode stenosis measurement was 35% or less, the PPV of the DSA stenosis being 35% or less was 93%. These excellent results support the use of good quality B-Mode NASCET style stenosis measurement as the initial ultrasound measurement, with Doppler ultrasound only being performed when the B-mode stenosis measurement is greater than 35% or if the B-mode image is unsatisfactory. This approach would save considerable time enabling better utilization of ultrasound resources.
Rotstein et al. (Fri,) conducted a observational in Internal carotid artery stenosis. Direct B-mode NASCET-style stenosis measurement vs. Digital subtraction angiography (DSA) was evaluated on Detection of >50% and >80% stenosis. Direct B-mode NASCET-style stenosis measurement combined with Doppler parameters achieved 100% sensitivity for detecting >50% and >80% internal carotid artery stenosis.