Simplified ultrasound protocol for the exclusion of clinically significant carotid artery stenosis

Autor: Björn Kragsterman, Martin Björck, Demosthenes Dellagrammaticas, Anders Wanhainen, Dominika Högberg
Rok vydání: 2016
Předmět:
Male
medicine.medical_specialty
Carotid arteries
Cardiology
030204 cardiovascular system & hematology
Sensitivity and Specificity
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Image Processing
Computer-Assisted
Carotid stenosis
medicine
Humans
Mass Screening
Cardiac and Cardiovascular Systems
Prospective Studies
cardiovascular diseases
Prospective cohort study
Mass screening
Aged
Ultrasonography
Protocol (science)
Kardiologi
ultrasound
business.industry
screening
Ultrasound
Ultrasonography
Doppler
Original Articles
General Medicine
Middle Aged
medicine.disease
Stenosis
Predictive value of tests
Carotid artery.internal
cardiovascular system
Female
Radiology
business
Blood Flow Velocity
Carotid Artery
Internal
030217 neurology & neurosurgery
Aortic Aneurysm
Abdominal
Zdroj: Upsala Journal of Medical Sciences
ISSN: 2000-1967
0300-9734
DOI: 10.1080/03009734.2016.1201177
Popis: Objectives: To evaluate a simplified ultrasound protocol for the exclusion of clinically significant carotid artery stenosis for screening purposes. Material and methods: A total of 9,493 carotid arteries in 4,748 persons underwent carotid ultrasound examination. Most subjects were 65-year-old men attending screening for abdominal aortic aneurysm. The presence of a stenosis on B-mode and/or a mosaic pattern in post-stenotic areas on colour Doppler and maximum peak systolic velocity (PSV) in the internal carotid artery (ICA) were recorded. A carotid stenosis was defined as The North American Symptomatic Carotid Endarterectomy Trial (NASCET) >20% and a significant stenosis as NASCET >50%. The kappa (kappa) statistic was used to assess agreement between methods. Sensitivity, specificity, positive predictive (PPV), and negative predictive (NPV) values were calculated for the greyscale/mosaic method compared to conventional assessment by means of PSV measurement. Results: An ICA stenosis was found in 121 (1.3%) arteries; 82 (0.9%) were graded 20%-49%, 16 (0.2%) were 50%-69%, and 23 (0.2%) were 70%-99%. Eighteen (0.2%) arteries were occluded. Overall, the greyscale/mosaic protocol showed a moderate agreement with ICA PSV measurements for the detection of carotid artery stenosis, x=0.455. The sensitivity, specificity, PPV, and NPV for detection of >20% ICA stenosis were 91% (95% CI 0.84-0.95), 97% (0.97-0.98), 31% (0.26-0.36), and 97% (0.97-0.97), respectively. The corresponding figures for >50% stenosis were 90% (0.83-0.95), 97% (0.97-0.98), 11% (0.08-0.15), and 100% (0.99-1.00). Conclusion: Compared with PSV measurements, the simplified greyscale/mosaic protocol had a high negative predictive value for detection of >50% carotid stenosis, suggesting that it may be suitable as a screening method to exclude significant disease.
Databáze: OpenAIRE
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