Critical appraisal of the Carotid Duplex Consensus criteria in the diagnosis of carotid artery stenosis

Abstract

Background: Clinicians have relied on published institutional experience for interpreting carotid duplex ultrasound studies (CDUS). This study will validate the ultrasound imaging consensus criteria published in 2003.

Methods: The CDUS and angiography results of 376 carotid arteries were analyzed. Receiver-operating characteristic (ROCs) curves were used to compare peak systolic velocities (PSVs), end-diastolic velocities (EDVs) of the internal carotid artery (ICA), and ICA/common carotid (CCA) ratios in detecting < 50%, 50% to 69% (ICA PSV of 125-230 cm/s), and 70% to 99% (PSV of ≥ 230 cm/s) stenosis according to the consensus criteria.

Results: The consensus criteria uses a PSV of 125 to 230 cm/s for detecting angiographic stenosis of 50% to 69%, which has a sensitivity of 93%, specificity of 68%, and overall accuracy of 85%. A PSV of ≥ 230 cm/s for ≥ 70% stenosis had a sensitivity of 99%, specificity of 86%, and overall accuracy of 95%. ROC curves showed that the ICA PSV was significantly better (area under the curve [AUC], 0.97) than EDV (AUC, 0.94) or ICA/CCA ratio (AUC, 0.84; P = .036) in detecting ≥ 70% stenosis and ≥ 50% stenosis. Pearson correlations showed a statistical difference between the correlation of PSV with angiography (0.833; 95% confidence interval [CI], 0.8-0.86), EDV with angiography (0.755; 95% CI, 0.71-0.80), and ICA/CCA systolic ratio with angiography (0.601; 95% CI, 0.53-0.66; P < .0001) in detecting 70% to 99% stenosis. Adding the EDV values or the ratios to the PSV values did not improve accuracy. The consensus criteria for diagnosing 50% to 69% stenosis can be significantly improved by using an ICA PSV of 140 to 230 cm/s, with a sensitivity of 94%, specificity of 92%, and overall accuracy of 92%.

Conclusions: The consensus criteria can be accurately used for diagnosing ≥ 70% stenosis; however, the accuracy can be improved for detecting 50% to 69% stenosis if the ICA PSV is changed to 140 to < 230 cm/s.