Color-flow doppler-assisted duplex imaging fails to detect ulceration in high-grade internal carotid artery stenosis

• Published in: Journal of vascular surgery Vol. 23; no. 3; pp. 461 - 465
• Main Authors: Sitzer, Matthias, Müller, Wolfram, Rademacher, Jörg, Siebler, Mario, Hort, Waldemar, Kniemeyer, H.-W., Steinmetz, Helmuth
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-03-1996; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiovascular system; Carotid Artery, Internal - diagnostic imaging; Carotid Artery, Internal - pathology; Carotid Artery, Internal - surgery; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - pathology; Carotid Stenosis - surgery; Endarterectomy, Carotid; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Observer Variation; Reproducibility of Results; Ulcer - diagnostic imaging; Ulcer - pathology; Ulcer - surgery; Ultrasonic investigative techniques; Ultrasonography, Doppler, Color; Sonography; Doppler ultrasound study; Human; Nervous system diseases; Internal carotid; Stenosis; Cardiovascular disease; Duplex ultrasonography; Color image; Cerebral disorder; Arterial disease; Vascular disease; Atherosclerotic plaque; Atherosclerosis; Central nervous system disease; Echography; Diagnosis; Ulceration; Cerebrovascular disease
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/S0741-5214(96)80011-5

Purpose: Pathoanatomic studies suggest that plaque surface disruption, particularly ulceration, plays a key role in the destabilization of internal carotid artery stenosis. Until now, the validity of color-flow Doppler-assisted duplex imaging in detecting such pathoanatomically defined plaque surface abnormalities is unclear.
Methods: We prospectively determined the interobserver reliability and validity of detecting plaque ulceration by means of preoperative color-flow Doppler-assisted duplex imaging in 43 consecutive patients with high-grade (≥70%) internal carotid artery stenosis, comparing these ultrasonographic findings with pathoanatomic evaluations of the corresponding endarterectomy specimens.
Results: Interobserver reliabilities for detecting carotid plaque ulceration were κ=0.57 for ultrasonography and κ=0.82 for the pathologic reference method. Color-flow Doppler-assisted duplex imaging (observer consensus) failed to detect pathoanatomically defined ulceration (X
2=0.43;
p=0.51). Likewise, sensitivity, specificity, overall accuracy, and positive predictive value were poor (33%, 67%, 56%, and 46%, respectively).
Conclusions: We conclude from our data that color-flow Doppler-assisted duplex imaging is not a reliable or valid means to identify plaque ulceration in high-grade carotid artery lesions.