title: Improvement in accuracy of diagnosis of carotid artery stenosis with duplex ultrasound scanning with combined use of linear array 7.5 MHz and convex array 3.5 MHz probes: validation versus 489 arteriographic procedures.
abstract: OBJECTIVE
  Validity of a method to improve the accuracy of carotid artery duplex scanning was tested in comparison with arteriography.
  
  
  METHODS
  In 489 patients who had not previously undergone arteriography, 978 carotid arteries were examined with duplex ultrasound scanning. In method A, a linear array 7.5 MHz transducer with pulsed-wave 4.7 MHz Doppler scanning was used. For the diagnosis and grading of carotid stenosis, peak systolic and end-diastolic velocity of the Doppler waves were recorded. Method B consisted of complete ultrasound imaging and color-flow mapping with a convex array 3.5 MHz transducer with pulsed-wave 2.8 MHz Doppler scanning in all patients who had previously undergone method A. Further velocity measurements were performed at the sites of stenosis. The results of methods A and B were compared with data from neurologic assessment and arteriographic studies.
  
  
  RESULTS
  Method B showed significantly higher diagnostic agreement with arteriography than did method A (K 95% confidence interval [CI], 0.87-0.93 vs 0.79-0.85; P <.05), and the number of mistakes in grading stenosis was significantly lower (primarily because of decreased overestimation) in patients with internal carotid kinking (>60 degrees of angulation) (P <.05), distal stenosis (>20 mm from bifurcation) (P <.01), or wide acoustic shadowing (>1 cm) (P <.01) and in those without these conditions (P <.05). Compared with arteriography, diagnostic accuracy with the new method proved higher for carotid stenoses 50% or greater, 60% or greater, 70% or greater, and 80% or greater; no statistically significant difference was found for carotid stenosis 96% or greater or for carotid occlusion. Compared with data from neurologic assessment and arteriography, method B proved more accurate than method A in designating patients for carotid endarterectomy (P =.014).
  
  
  CONCLUSIONS
  The new method significantly improved diagnostic reliability of duplex ultrasound scanning, especially in carotid arteries with kinking, distal stenosis, or wide acoustic shadowing (32.2% of all arteries studied). In clinical practice, we suggest additional use of a lower frequency transducer in cases in which these three conditions are found or suspected at first scanning.
authors.affiliation: Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Monaldi Hospital, Division of Cardiovascular Surgery, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Leonardo
authors.forename: Basilio
authors.initials: B
authors.lastname: Crescenzi
authors.forename: Roberto
authors.initials: R
authors.lastname: Cotrufo
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tecame
authors.forename: Luca S
authors.initials: LS
authors.lastname: De Santo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Della Corte
authors.forename: Mario
authors.initials: M
authors.lastname: Fratta
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cotrufo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D016893:Carotid Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014159:Transducers; D018616:Ultrasonography, Doppler, Duplex / Q000295:instrumentation* / Q000379:methods*