Near-occlusion is difficult to diagnose with common carotid ultrasound methods
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Published:2021-03-13
Issue:5
Volume:63
Page:721-730
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ISSN:0028-3940
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Container-title:Neuroradiology
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language:en
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Short-container-title:Neuroradiology
Author:
Johansson EliasORCID, Vanoli Davide, Bråten-Johansson Isa, Law Lucy, Aviv Richard I, Fox Allan J
Abstract
Abstract
Purpose
To assess the sensitivity and specificity of common carotid ultrasound method for carotid near-occlusion diagnosis.
Methods
Five hundred forty-eight patients examined with both ultrasound and CTA within 30 days of each other were analyzed. CTA graded by near-occlusion experts was used as reference standard. Low flow velocity, unusual findings, and commonly used flow velocity parameters were analyzed.
Results
One hundred three near-occlusions, 272 conventional ≥50% stenosis, 162 <50% stenosis, and 11 occlusions were included. Carotid ultrasound was 22% (95%CI 14–30%; 23/103) sensitive and 99% (95%CI 99–100%; 442/445) specific for near-occlusion diagnosis. Near-occlusions overlooked on ultrasound were found misdiagnosed as occlusions (n = 13, 13%), conventional ≥50% stenosis (n = 65, 63%) and < 50% stenosis (n = 2, 2%). No velocity parameter or combination of parameters could identify the 65 near-occlusions mistaken for conventional ≥50% stenoses with >75% sensitivity and specificity.
Conclusion
Near-occlusion is difficult to diagnose with commonly used carotid ultrasound methods. Improved carotid ultrasound methods are needed if ultrasound is to retain its position as sole preoperative modality.
Funder
Knut och Alice Wallenbergs Stiftelse Region Västerbotten The research fund for neurological research at the university hospital of northern Sweden The Swedish Stroke fund The Northern Swedish Stroke fund Svenska Läkaresällskapet
Publisher
Springer Science and Business Media LLC
Subject
Cardiology and Cardiovascular Medicine,Neurology (clinical),Radiology, Nuclear Medicine and imaging
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