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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 25:1856-1860, November-December 2004
© 2004 American Society of Neuroradiology

HEAD AND NECK

Combined Use of Color Duplex Ultrasonography and B-Flow Imaging for Evaluation of Patients with Carotid Artery Stenosis

Muharrem Tola^a, Mehmet Yurdakul^a and Turhan Cumhur^a

^a Department of Radiology, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey

Address reprint requests to Muharrem Tola, Department of Radiology, Türkiye Yüksek Ihtisas Hospital, Kzlay Sokak No: 4, 06100 Shhiye, Ankara, Turkey

BACKGROUND AND PURPOSE: Color duplex ultrasonography (CDU) is a standard method of noninvasive evaluation of internal carotid artery stenosis (ICAS). B-flow imaging (BFI), on the other hand, is a newer method. We investigated the accuracy of the two noninvasive tests—CDU and BFI—each separately and as a combination of the two tests by comparing with digital subtraction angiography as a reference standard.

METHODS: We performed CDU, BFI, and digital subtraction angiography on 95 consecutive patients with ICAS. Separate and combined test results of CDU and BFI were compared with digital subtraction angiography results.

RESULTS: For identifying 70% to 99% ICAS, as CDU criterion, the ratio of internal carotid artery to common carotid artery peak systolic velocity had the highest diagnostic accuracy (sensitivity, 94%; specificity, 96%). The sensitivity and specificity of BFI were 65% and 98%, respectively. With CDU and BFI, results were concordant in 144 (89%) cases for 70% to 99% ICAS. Sensitivity and specificity of combined CDU and BFI results for identification of ICAS were 95% and 99%, respectively. The misclassification rates of CDU and BFI were 4.7% and 8.1%, respectively. When combined test results were concordant, the misclassification rate decreased to 1.4%.

CONCLUSION: CDU showed a slightly better accuracy than did BFI in the diagnosis of carotid artery stenosis. Combined use of CDU and BFI is more accurate than use of either test alone.

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