Validation of Multiparametric Ultrasonography Criteria with Digital Subtraction Angiography in Carotid Artery Disease: A Prospective Multicenter Study

Author:

Barlinn Kristian1,Rickmann Henning2,Kitzler Hagen3,Krogias Christos4,Strohm Henning5,Abramyuk Andrij3,Barlinn Jessica1,Siepmann Timo1,Rabahi Ali1,Graehlert Xina6,Schwanebeck Uta6,Winzer Simon1,Arnold Sebastian7,Moennings Peter8,Pallesen Lars-Peder1,Bodechtel Ulf1,Mudra Harald5,Linn Jennifer3,Reichmann Heinz1,Alexandrov Andrei9,Gahn Georg2,Weiss Norbert10,Puetz Volker1

Affiliation:

1. Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany

2. Department of Neurology, Municipal Hospital Karlsruhe gGmbH, Karlsruhe, Germany

3. Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany

4. Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Germany

5. Department of Cardiology, Klinikum Muenchen-Neuperlach, Munich, Germany

6. Coordination Center for Clinical Trials, University Hospital Carl Gustav Carus, Dresden, Germany

7. Department of Neuroradiology, Municipal Hospital Karlsruhe gGmbH, Karlsruhe, Germany

8. Department of Neuroradiology, St. Josef Hospital, Ruhr University Bochum, Germany

9. Department of Neurology, The University of Tennessee Health Science Center, Memphis, United States

10. Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital Carl Gustav Carus, Dresden, Germany

Abstract

Abstract Purpose The German Society of Ultrasound in Medicine (DEGUM) recently revised its multiparametric criteria for duplex ultrasonography (DUS) grading of internal carotid artery (ICA) disease. We determined the diagnostic accuracy of the revised DEGUM criteria for ultrasonography grading of ICA disease in a prospective multicenter study. Materials and Methods We evaluated consecutive patients who underwent digital subtraction angiography of the extracranial carotid arteries at four tertiary care hospitals. Blinded investigators graded ICA disease according to DEGUM-recommended ultrasonography criteria and calculated NASCET-type percent stenosis from angiography images. Endpoints included overall classification accuracy, prediction of clinically relevant disease categories and between-test agreement in the continuous range of percent stenosis. Results A total of 121 patients (median age: 69 [IQR, 16] years; 74 % men; median time between DUS and angiography: 1 day [IQR, 2]) provided 163 DUS-angiography carotid artery pairs. The classification accuracy of the DEGUM criteria to predict stenosis within 10 % increments as compared to angiography was 34.9 % (95 % CI, 28.0 – 42.6). The sensitivity of DUS for the detection of moderate (50 – 69 %) and severe (70 – 99 %) stenosis was 35 % and 81 %, with an overall accuracy of 73 % and 74 %, respectively. The specificity was 89 % and 69 %, respectively. Considering the continuous spectrum of the disease (0 – 100 %), the Bland-Altman interval limit of agreement was 51 %. Conclusion At laboratories experienced with ultrasound grading of the extracranial ICA, the revised DEGUM multiparametric ultrasonography criteria do not eliminate the need for a confirmatory test for the identification of clinically relevant grades of the disease.

Publisher

Georg Thieme Verlag KG

Subject

Radiology Nuclear Medicine and imaging

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