Automated contrast column density measurement on intra-arterial quantitative angiography was the best predictor of ≥50% diameter stenosis by IVUS (AUC 0.87), while CTA was the only independent non-invasive diagnostic modality.
Observational (n=300)
Blinded analysts
No
How do DUS, CTA, and iQA compare to IVUS in determining carotid artery stenosis severity in patients referred for potential revascularization?
Significant imaging modality-dependent variations exist in carotid stenosis severity determination, with CTA being the most accurate independent non-invasive modality compared to IVUS.
Effect estimate: AUC 0.87
p-value: p=<0.001
PURPOSE: Different non-invasive and invasive imaging modalities are used to determine carotid artery stenosis severity that remains a principal parameter in clinical decision-making. We compared stenosis degree obtained with different modalities against vascular imaging gold standard, intravascular ultrasound, IVUS. METHODS: 300 consecutive patients (age 47-83 years, 192 men, 64% asymptomatic) with carotid artery stenosis of " ≥ 50%" referred for potential revascularization received as per study protocol (i) duplex ultrasound (DUS), (ii) computed tomography angiography (CTA), (iii) intraarterial quantitative angiography (iQA) and (iv) and (iv) IVUS. Correlation of measurements with IVUS (r), proportion of those concordant (within 10%) and proportion of under/overestimated were calculated along with recipient-operating-characteristics (ROC). RESULTS: For IVUS area stenosis (AS) and IVUS minimal lumen area (MLA), there was only a moderate correlation with DUS velocities (peak-systolic, PSV; end-diastolic, EDV; r values of 0.42-0.51, p < 0.001 for all). CTA systematically underestimated both reference area and MLA (80.4% and 92.3% cases) but CTA error was lesser for AS (proportion concordant-57.4%; CTA under/overestimation-12.5%/30.1%). iQA diameter stenosis (DS) was found concordant with IVUS in 41.1% measurements (iQA under/overestimation 7.9%/51.0%). By univariate model, PSV (ROC area-under-the-curve, AUC, 0.77, cutoff 2.6 m/s), EDV (AUC 0.72, cutoff 0.71 m/s) and CTA-DS (AUC 0.83, cutoff 59.6%) were predictors of ≥ 50% DS by IVUS (p < 0.001 for all). Best predictor, however, of ≥ 50% DS by IVUS was stenosis severity evaluation by automated contrast column density measurement on iQA (AUC 0.87, cutoff 68%, p < 0.001). Regarding non-invasive techniques, CTA was the only independent diagnostic modality against IVUS on multivariate model (p = 0.008). CONCLUSION: IVUS validation shows significant imaging modality-dependent variations in carotid stenosis severity determination.
Tekieli et al. (Mon,) conducted a observational in Carotid artery stenosis (n=300). Duplex ultrasound (DUS), computed tomography angiography (CTA), and intraarterial quantitative angiography (iQA) vs. Intravascular ultrasound (IVUS) was evaluated on Predictor of ≥50% diameter stenosis by IVUS (AUC 0.87, p=<0.001). Automated contrast column density measurement on intra-arterial quantitative angiography was the best predictor of ≥50% diameter stenosis by IVUS (AUC 0.87), while CTA was the only independent non-invasive diagnostic modality.