Carotid Intima-Media Thickness Manual Measurements: Intraoperator and Interoperator Agreements Under A Strict...

The aim of this study was to assess the intraoperator and interoperator agreement for manual measurements of intima-media thickness (IMT) performed under a strict carotid ultrasound technical protocol.

Two blinded experienced operators independently performed an ultrasound examination at the distal common carotid of 242 subjects in the same patient's position, diastolic phase, probe type, zooming, and depth. Thirty-six subjects were reevaluated in another time point. Three different-angle manual measurements (IMTindiv) were obtained. Interoperator agreements for each IMTindiv, and their mean (IMTmean) and maximum (IMTmax) values, were assessed with the intraclass correlation coefficient and Bland-Altman analysis. Intraoperator agreement was tested taking advantage of the second ultrasound round in 36 subjects.

IMTmean agreements (intraoperator, 0.665-0.913; interoperator, 0.856-0.897) were higher than IMTmax (intraoperator, 0.435-0.793; interoperator, 0.631-0.718) and any IMTindiv (intraoperator, 0.355-0.676; interoperator, 0.590-0.717). Despite the small systematic error for IMTmean (intraoperator, ≤0.03; interoperator, ≤0.02 mm), at best of times, the sampling error size reached at least 0.28 and 0.25 mm for intraoperator and interoperator agreements, respectively, and was never less than 0.13 mm.

Although IMTmean agreement is excellent under a strict protocol, limits of agreement might be too wide to consider carotid ultrasound a robust cardiovascular risk biomarker.