What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Carotid disease (n=918). Intervention: 3D ultrasound vs. 2D ultrasound and angiography. Primary outcome: Inter-method agreement between 3D ultrasound and 2D ultrasound (r=0.89, 95% CI 0.83-0.95).

What does this research mean for the field?

3D ultrasound demonstrates excellent intra- and inter-observer reproducibility and excellent agreement with 2D ultrasound and angiography for the evaluation of carotid disease. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

February 7, 2023Open Access

Is 3D ultrasound reliable for the evaluation of carotid disease? A systematic review and meta-analysis

SSSalahaden R. SultanKing Abdulaziz University FBFatima T. BashmailKing Abdulaziz University NANouf AlzahraniUniversity of Leeds

Key Result

3D ultrasound demonstrated excellent agreement with 2D ultrasound (r=0.89) and angiography (r=0.73) for the evaluation of carotid disease.

Study Design

Type

Meta-Analysis (n=918)

Structured PICO

Does 3D ultrasound provide reliable and reproducible evaluation of carotid disease compared to 2D ultrasound and angiography?

Population

918 stenosed carotid arteries from 16 studies evaluating carotid disease (plaque measurements, characteristics, and degree of stenosis)

Intervention

3D ultrasound (3DUS)

Comparator

2D ultrasound (2DUS) and angiography

Outcome

Intra- and inter-observer reproducibility and inter-method agreement (correlation coefficients)surrogate

3D ultrasound is a highly reproducible and reliable imaging modality for evaluating carotid disease, demonstrating excellent agreement with both 2D ultrasound and angiography.

Main Result

Effect estimate: r=0.89 (95% CI 0.83-0.95)

Limitations

Heterogeneity between studies in terms of scanning techniques and imaging mode
Publication bias in studies assessing inter-observer reproducibility and inter-method agreement between 3DUS and 2DUS
Significant relationship between quality score and studies assessing intra-observer reproducibility and inter-method agreement

Abstract

AIM: Studies assessing the use of 3D ultrasound (3DUS) for the evaluation of carotid disease reported varying views among observers about its reliability vis-à-vis 2DUS or angiography; ratings provided ranged from poor to excellent. Thisstudy aims to systematically review and analyze the reliability of 3DUS for the evaluation of carotid disease. MATERIALS AND METHODS: The PubMed database was searched for studies that evaluated carotid disease (i.e. plaque measurements and characteristics and degree of stenosis) using 3DUS. RESULTS: Sixteen studies comprising a total of 918 stenosed carotids were reviewed and meta-analyzed. Data on intra- and inter-observer reproducibility and inter-method agreement (i.e. 3DUS vs 2D and 3DUS vs angiography) were analyzed. Overall analysis showed excellent intra- and inter-observer reproducibility (intraobserver: correlation coefficient r=0.88, 95% confidence intervals (CI) 0.84-0.92; intra-observer: r=0.91, 95% CI 0.87-0.95). The analysis also showed excellent agreement between 3DUS and 2DUS (r=0.89, 95% CI 0.83-0.95) and between 3DUS and angiography (r=0.73, 95% CI 0.44-0.1). CONCLUSION: 3DUS has excellent intra- and inter-observer reproducibility and excellent agreement with 2DUS and angiography for the evaluation of carotid disease. Further studies assessing the reliability ofcarotid plaque characteristics using 3DUS in symptomatic and asymptomatic patients are required.

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