title: Is B-mode ultrasound alone a sufficient screening tool for carotid stenosis? A pilot study.
abstract: BACKGROUND
  Carotid ultrasound is performed solely in hospital ultrasound departments or outpatient labs, using both B- and Doppler modes. We hypothesize that B-mode without Doppler can be used to classify patients as having carotid stenosis (CS) above or below 50%. Our objective is to determine the frequency with which a CS >50% is found using Doppler when no such stenosis was visible using B-mode.
  
  
  METHODS
  This was a retrospective study of 100 patients referred to the stroke clinic and 100 patients referred for carotid endarterectomy (CEA). All patients had an elective carotid ultrasound done at Health Sciences North. The ultrasound reports were mixed together and blinded. Investigators determined if there was a CS of greater or less than 50% based on the carotid diagram. These results were compared to the degree of CS found on Doppler.
  
  
  RESULTS
  In the CEA group, there were 198 ultrasounds, with 153 showing a CS of >50%. Only one case of CS >50% was missed by B-mode. In the clinic group, 32 of 192 ultrasounds showed a CS of >50%. None were missed by B-mode. B-mode had a sensitivity and negative predictive value of 100% and a specificity of 65%.
  
  
  CONCLUSIONS
  This study supports the theory that it may be possible to use B-mode ultrasound without Doppler to reliably determine if there is CS above or below 50%. Further research is required before carotid ultrasound using B-mode alone can be recommended.
authors.affiliation: Emergency Department, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto M4N 3M5, ON, Canada.
authors.forename: Tina
authors.initials: T
authors.lastname: Bhandari
authors.affiliation: Emergency Department, Health Sciences North, 41 Ramsey Lake Road, Sudbury P3E 5J1, ON, Canada.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Socransky
keywords: Carotid stenosis; Doppler ultrasonography; Duplex ultrasonography; Point-of-care ultrasonography; Ultrasonography