Observer variability in evaluating extracranial carotid artery stenosis.

Area of Science:

• Vascular imaging and diagnostics
• Radiology and medical imaging
• Cardiovascular disease assessment

Background:

• Carotid bifurcation atherosclerosis is a significant cause of stroke.
• Accurate stenosis quantification is crucial for clinical decision-making.
• Inter- and intra-reader variability in interpreting imaging can impact patient care.

Purpose of the Study:

• To assess the reliability of carotid bifurcation stenosis evaluation by multiple readers.
• To quantify intraobserver and interobserver variability in estimating percent stenosis.
• To determine the impact of oblique views on stenosis and lesion characterization.

Main Methods:

• Review of 128 cervical carotid arteriograms by three independent readers, twice.
• Estimation of stenosis using calipers to the nearest 5%.
• Qualitative characterization of lesions (smooth, irregular, ulcerated).

Main Results:

• High intraobserver correlation coefficients (.94 overall, .98 for internal carotid artery).
• High interobserver correlation coefficients (.92 overall, .97 for internal carotid artery).
• Oblique views did not affect stenosis estimates but improved detection of irregularity and ulceration.

Conclusions:

• Consistent and reliable assessment of carotid bifurcation stenosis is achievable.
• High agreement rates support the use of arteriography for stenosis evaluation.
• Oblique views may enhance lesion characterization but do not alter stenosis quantification.