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 RR12. CT Angiography-derived Duplex Ultrasound Velocity Criteria in Patients with Carotid Artery Stenosis

​Adam J. Doyle, Jonathon J. Stone, Anthony Carnicelli, Sean J. Hislop, Michael J. Singh, Jason Kim, Jennifer Ellis, Nicholas J. Gargiulo, Ankur Chandra, David L. Gillespie
University of Rochester Medical Center, Rochester, NY.

OBJECTIVES: Widely used carotid duplex ultrasound (DUS) velocity criteria (VC) to determine percent stenosis, and consequential benefit of carotid endarterectomy, are based on conventional angiography. DUS VC have not been developed with the use of CT angiography (CTA) derived measurements. The objective was to determine optimal carotid DUS VC from CTA-derived measurements with the NASCET method for 50 and 80% stenosis.

METHODS: A retrospective review of all patients who underwent carotid DUS and CTA from 2000-2009 was performed. Vessel diameters were made on CTA and DUS velocities recorded. Percent stenosis was calculated using the NASCET method. Receiver operating characteristic (ROC) curves were generated for internal carotid artery (ICA) peak systolic velocity (PSV), ICA end diastolic velocity (EDV), and ICA PSV to common carotid artery PSV ratio (PSVR) for 50 and 80% stenosis. Velocity cutpoints were determined with equal weighting of sensitivity and specificity.

RESULTS: A total of 610 vessels were analyzed to create the ROC curves (Table). For 50% stenosis analysis yielded ideal cutpoints for PSV, EDV, and PSVR of 130 cm/sec, 42 cm/sec, and 1.75. For 80% stenosis analysis yielded ideal cutpoints for PSV, EDV, and PSVR of 297 cm/sec, 84 cm/sec, and 3.06.

CONCLUSIONS: CTA-derived DUS velocity criteria appear to be reliable in defining 50% and 80% stenosis in patients with carotid artery stenosis. The carotid DUS VC defined in this study is different than either the Zwieble or Standness criteria for the same percent stenosis.

AUTHOR DISCLOSURES: A. Carnicelli, Nothing to disclose; A. Chandra, Nothing to disclose; A. J. Doyle, Nothing to disclose; J. Ellis, Nothing to disclose; N. J. Gargiulo, Nothing to disclose; D. L. Gillespie, Nothing to disclose; S. J. Hislop, Nothing to disclose; J. Kim, Nothing to disclose; M. J. Singh, Nothing to disclose; J. J. Stone, Nothing to disclose.

 

Table

AUC (SE)
95% Confidence Interval
Velocity Criteria
Sensitivity (%)
Specificity (%)
>50% PSV
0.926 (0.012)
0.904-0.949
≥130 cm/sec
87.9
84.3
>50% EDV
0.884 (0.016)
0.852-0.916
≥42 cm/sec
81.1
84.7
>50% ICA/CCA PSV ratio
0.924 (0.012)
0.902-0.947
≥1.75
87.4
85.8
>80% PSV
0.946 (0.010)
0.925-0.966
≥297 cm/sec
88.9
88.4
>80% EDV
0.954 (0.013)
0.929-0.979
≥84 cm/sec
93.3
88.4
>80% ICA/CCA PSV ratio
0.913 (0.022)
0.869-0.957
≥3.06
93.3
84.6

 

Posted April 2012

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