Validation of a basic neurosonology laboratory for detecting cervical carotid artery stenosis
C de la Cruz Cosme1, M S Dawid Milner2, G Ojeda Burgos3
1Servicio de Neurología, Hospital Universitario Virgen de la Victoria, Málaga, España.
Insights
Doppler ultrasound effectively detects severe carotid artery stenosis in stroke patients, showing high sensitivity and specificity. This validated method is superior to carotid duplex for identifying both cervical and intracranial stenosis.
Area of Science:
- Neurology
- Vascular Imaging
- Diagnostic Ultrasound
Background:
- Atherothrombotic origin is a common cause of ischemic stroke.
- Detecting carotid artery stenosis is crucial for managing ischemic stroke.
- Doppler ultrasound is a preferred, accessible, and reliable tool for diagnosing carotid artery stenosis, requiring laboratory-specific validation.
Purpose of the Study:
- To validate Doppler ultrasound for detecting severe carotid artery stenosis in a specific laboratory setting.
Main Methods:
- An observational, descriptive study evaluated diagnostic tests.
- Neurologist-performed transcranial and cervical carotid Doppler ultrasound results were compared with radiologist-performed carotid duplex scans.
- Arteriography (MR angiography, CT angiography, or conventional arteriography) served as the gold standard.
Main Results:
- Doppler ultrasound demonstrated 95% sensitivity and 100% specificity for carotid artery stenosis >70%, outperforming carotid duplex (87% sensitivity, 94% specificity).
- For intracranial stenosis, Doppler ultrasound achieved 78% sensitivity and 98% specificity.
- The study included 228 patients.
Conclusions:
- Doppler ultrasound is a valuable diagnostic tool for cervical carotid artery stenosis in the neurosonology laboratory.
- This technique proved superior to carotid duplex, even without B-mode imaging.
- Doppler ultrasound is also effective for detecting intracranial stenosis.
Introduction:
Most of the cases of ischaemic stroke in our setting are of atherothrombotic origin. Detecting intracranial and cervical carotid artery stenosis in patients with ischaemic stroke is therefore essential. Ultrasonography has become the tool of choice for diagnosing carotid artery stenosis because it is both readily accessibility and reliable. However, use of this technique must be validated in each laboratory. The purpose of this study is to validate Doppler ultrasound in our laboratory as a means of detecting severe carotid artery stenosis.
Patients And Methods:
We conducted an observational descriptive study to evaluate diagnostic tests. The results from transcranial and cervical carotid Doppler ultrasound scans conducted by neurologists were compared to those from carotid duplex scans performed by radiologists in patients diagnosed with stroke. Arteriography was considered the gold standard (MR angiography, CT angiography, or conventional arteriography).
Results:
Our sample included 228 patients. Transcranial and cervical carotid Doppler ultrasound showed a sensitivity of 95% and specificity of 100% for detection of carotid artery stenosis > 70%, whereas carotid duplex displayed a sensitivity of 87% and a specificity of 94%. Transcranial carotid Doppler ultrasound achieved a sensitivity of 78% and a specificity of 98% for detection of intracranial stenosis.
Conclusions:
Doppler ultrasound in our neurosonology laboratory was found to be a useful diagnostic tool for detecting cervical carotid artery stenosis and demonstrated superiority to carotid duplex despite the lack of B-mode. Furthermore, this technique was found to be useful for detecting intracranial stenosis.
