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Concordance rates of Doppler ultrasound and CT angiography in the grading of carotid artery stenosis: a systematic literature review.
MedLine Citation:
PMID:  22064974     Owner:  NLM     Status:  Publisher    
Physicians have been increasingly relying on noninvasive imaging methods to grade carotid stenosis. The accuracy of Doppler ultrasound (DUS) and CT angiography (CTA) versus intra-arterial angiography (IA) has been assessed in many studies and at least two meta-analyses. Here, we performed a systematic review of studies that compared DUS to CTA. In a PubMed review of the literature from 2000 to 2009, we found 12 studies that compared DUS and CTA-based grading of carotid stenosis. Only 4 of them included at least 20 patients and provided data to classify the diseased arteries into the following categories: mild, moderate or severe NASCET stenosis or occlusion. We extracted 431 arteries from 244 patients (range per study: 48-164). It was not possible to distinguish symptomatic from asymptomatic stenoses. Nearly half arteries had severe stenosis (46% based on DUS and 43% based on CTA). The weighted kappa was 0.85 (95% CI 0.76-0.94), and the accuracy was 0.78. When the arteries were classified into medical and potentially surgical groups, the kappa was 0.76 (95% CI 0.70-0.83), and the accuracy was 0.89. Overall, 17 % of the stenoses classified as medical based on DUS were reclassified as surgical based on CTA and 14 % of the stenoses classified as medical based on CTA were reclassified as surgical based on DUS. The sparse available data comparing DUS and CTA suggest that the grading of a carotid stenosis as medical or potentially surgical remains uncertain in a relatively high proportion of patients.
Chiara Zavanone; Emma Ragone; Yves Samson
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-11-8
Journal Detail:
Title:  Journal of neurology     Volume:  -     ISSN:  1432-1459     ISO Abbreviation:  -     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-11-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0423161     Medline TA:  J Neurol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
AP-HP Urgences Cérébro-Vasculaires, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie Paris VI, Paris Universitas, 47-83 Boulevard de l'Hôpital, 75013, Paris, France,
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