Noninvasive carotid artery testing. A meta-analytic review

Area of Science:

• Vascular Surgery
• Diagnostic Imaging
• Neurology

Background:

• Carotid artery stenosis is a significant risk factor for stroke.
• Accurate noninvasive diagnostic tests are crucial for patient management.
• Several noninvasive imaging modalities exist for evaluating carotid artery disease.

Purpose of the Study:

• To compare the operating characteristics of six noninvasive tests for carotid artery stenosis.
• To assess the diagnostic accuracy of various noninvasive methods against carotid angiography.
• To provide evidence for selecting appropriate screening tools for carotid artery atherosclerosis.

Main Methods:

• A systematic literature search identified 568 relevant articles.
• Studies were selected if they used carotid angiography as a reference standard and provided data for contingency tables.
• Sensitivity, specificity, ROC curves, and summary measures of effectiveness were calculated for each test.

Main Results:

• Carotid duplex ultrasonography, carotid Doppler ultrasonography, and magnetic resonance angiography demonstrated high sensitivity (0.82-0.86) and specificity (0.98) for 100% occlusion.
• For 70% stenosis, these three tests plus supraorbital Doppler ultrasonography showed sensitivities of 0.83-0.86 and specificities of 0.89-0.94.
• Limiting analysis to high-quality studies did not significantly alter the results.

Conclusions:

• Carotid duplex ultrasonography, carotid Doppler ultrasonography, and magnetic resonance angiography are equally effective in detecting severe carotid artery stenosis (100% occlusion and ≥70% stenosis).
• Clinical decisions regarding the use of these tests may be influenced by factors like cost, availability, and local expertise.
• These imaging modalities are valuable for screening patients with potential carotid artery atherosclerosis requiring surgical consideration.