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Ultraschall Med 2015; 36(05): 487-493
DOI: 10.1055/s-0034-1398749
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Quantification of Internal Carotid Artery Stenosis with 3D Ultrasound Angiography

Quantifizierung von Stenosen der Arteria carotis interna mit 3D-Ultraschallangiografie
J. O. Pelz
1   Department of Neurology, University of Leipzig, Germany
,
A. Weinreich
1   Department of Neurology, University of Leipzig, Germany
,
D. Fritzsch
2   Department of Neuroradiology, University of Leipzig, Germany
,
D. Saur
1   Department of Neurology, University of Leipzig, Germany
› Author Affiliations
Further Information

Publication History

24 August 2014

24 November 2014

Publication Date:
21 January 2015 (online)

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Abstract

Purpose: The aim of this study was to evaluate a new method of three-dimensional ultrasound (3D-US) angiography of carotid vessels including 3D-US quantification of internal carotid artery (ICA) stenosis (ICAS).

Materials and Methods: Two neurologists performed native ultrasound scans of the brain-supplying carotid arteries in 73 probands (including 22 patients with 25 cases of ICAS) using a Toshiba Aplio 500 ultrasound machine equipped with the 3 D application of Curefab CS. Additionally, 25 probands underwent contrast-enhanced magnetic resonance angiography (CE-MRA) of the neck vessels.

Results: The mean length of the proximal ICA was 32.1 mm ± 9.8 mm & 31.3 mm ± 9.0 mm (each n = 97). The interrater reliability (intraclass correlation, ICC) was 0.75 ± 0.23 for the common carotid artery (CCA, n = 90) and 0.78 ± 0.21 (n = 92) for the ICA. The intermethod agreement between 3D-US angiography and CE-MRA was 0.67 ± 0.19 (n = 45) & 0.66 ± 0.19 (n = 44) for the CCA and 0.79 ± 0.17 (n = 47) & 0.75 ± 0.19 (n = 46) for the ICA. Quantification of ICAS applying 3D-US in comparison to 2D color-coded duplexsonography (2D-CDS) showed a moderate to good intermethod agreement both by the Bland and Altman analysis and by ICC (0.8 & 0.72; with each p < 0.001). The interrater reliability for quantification of ICAS was 0.79; p < 0.001.

Conclusion: Native 3D-US angiography of carotid vessels shows good interrater and intermethod agreement in comparison to CE-MRA. Together with a moderate to good intermethod and interrater agreement in the quantification of ICAS, when compared to 2D-CDS, 3D-US angiography is thus a promising complementary imaging technique for carotid artery disease.

Zusammenfassung

Ziel: In dieser Studie wurde eine neue Methode der drei-dimensionalen Ultraschallangiografie (3D-US) der hirnversorgenden Halsgefäße einschließlich der Quantifizierung von Stenosen der Arteria carotis interna (ICAS) evaluiert.

Material und Methoden: Zwei Neurologen untersuchten in 73 Probanden (davon 22 Patienten mit 25 ICAS) die extrakraniellen hirnversorgenden Gefäße mit einem Toshiba Aplio 500 Ultraschallgerät, das mit einer 3D-Anwendung von Curefab CS ausgerüstet war. Bei 25 Probanden wurde zusätzlich eine Kontrastmittel-Magnetresonanzangiografie der Halsgefäße (CE-MRA) durchgeführt.

Ergebnisse: Die mittlere Länge der proximalen Arteria carotis interna (ICA; jeweils n = 97) betrug 32.1 mm ± 9.8 mm bzw. 31.3 mm ± 9.0 mm. Die Interrater Übereinstimmung (Intraklassen-Korrelationskoeffizient, ICC) betrug 0.75 ± 0.23 für die Arteria carotis communis (CCA; n = 90) und 0.78 ± 0.21 (n = 92) für die ICA. Die Intermethoden Übereinstimmung (ICC) zwischen der 3D-US Angiografie und der CE-MRA lag bei 0.67 ± 0.19 (n = 45) bzw. 0.66 ± 0.19 (n = 44) für die CCA und bei 0.79 ± 0.17 (n = 47) bzw. 0.75 ± 0.19 (n = 46) für die ICA. Im Vergleich des 3D-US mit der konventionellen 2D-Farbduplexsonografie fand sich bei der Quantifizierung von ICAS eine moderate bis gute Intermethoden Übereinstimmung sowohl in der Bland und Altman Analyse als auch mittels ICC (0.8 bzw. 0.72; p jeweils < 0.001). Die Interrater Übereinstimmung für die Stenosenquantifizierung lag bei 0.79; p < 0,001.

Schlussfolgerung: Im Vergleich zur CE-MRA zeigt die native 3D-US Angiografie der extrakraniellen hirnversorgenden Gefäße eine gute Interrater und Intermethoden Übereinstimmung. Zusammen mit der moderaten bis guten Intermethoden und Interrater Übereinstimmung bei der Quantifizierung von ICAS, stellt die 3D-US Angiografie somit eine vielversprechende, komplementäre Bildgebungsmethode zur Untersuchung von Carotisstenosen dar.

Key words

carotid arteries - angiography - 3 D ultrasound - internal carotid artery stenosis - ultrasound color Doppler
 

  • References

  • 1 Grau AJ, Weimar C, Buggle F et al. Risk factors, outcome and treatment in subtypes of ischemic stroke: The German Stroke Data Bank. Stroke 2001; 32: 2559-2566
    CrossrefPubMedGoogle Scholar
  • 2 Nicolaides AN, Kakkos SK, Griffin M et al. Severity of asymptomatic carotid stenosis and risk of ipsilateral hemispheric ischaemic events: results from the ACSRS study. Eur J Vasc Endovasc Surg 2005; 30: 275-284
    CrossrefPubMedGoogle Scholar
  • 3 Arning C, Widder B, von Reutern G et al. Ultraschallkriterien zur Graduierung von Stenosen der A. carotis interna – Revision der DEGUM-Kriterien und Transfer in NASCET-Stenosierungsgrade. Ultraschall in Med 2010; 31: 251-257
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Wardlaw JM, Chappell FM, Best JJ et al. Non-invasive imaging compared with intra-arterial angiography in the diagnosis of symptomatic carotid stenosis: a meta-analysis. Lancet 2006; 367: 1503-1512
    CrossrefPubMedGoogle Scholar
  • 5 S3-Leitlinie Diagnostik, Therapie und Nachsorge der extracraniellen Carotisstenose AWMF-Registernummer 004–028. www.awmf.org Last accessed on 25 May 2013
    PubMedGoogle Scholar
  • 6 Kaufmann TJ, Huston J, Mandrekar JN et al. Complications of diagnostic cerebral angiography: Evaluation of 19826 consecutive patients. Radiology 2007; 243: 812-819
    CrossrefPubMedGoogle Scholar
  • 7 Widder B, Görtler M. Stenosen und Verschlüsse der extrakraniellen A. carotis. In: Widder B, Görtler M, (eds.): Doppler- und Duplexsonographie der hirnversorgenden Arterien. Berlin, Heidelberg, New York: Springer; 2004: 167-190
    CrossrefGoogle Scholar
  • 8 Yao J, van Sambeek MR, Dall'Agata A et al. Three-dimensional ultrasound study of carotid arteries before and after endarterectomy. Stroke 1998; 29: 2026-2031
    CrossrefPubMedGoogle Scholar
  • 9 Bendick PJ, Brown OW, Hernandez D et al. Three-dimensional vascular imaging using Doppler ultrasound. Am J Surg 1998; 176: 183-187
    CrossrefPubMedGoogle Scholar
  • 10 Keberle M, Jenett M, Beissert M et al. Three-dimensional power Doppler sonography in screening for carotid artery disease. J Clin Ultrasound 2000; 28: 441-451
    CrossrefPubMedGoogle Scholar
  • 11 Keberle M, Jenett M, Wittenberg G et al. Comparison of 3D power-doppler-ultrasound, color doppler ultrasound and digital subtraction angiography in carotid artery disease. Rofo 2001; 173: 133-138
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Wessels T, Harrer JU, Stetter S et al. Three-dimensional assessment of extracranial Doppler sonography in carotid artery Stenosis compared with digital subtraction angiography. Stroke 2004; 35: 1847-1851
    CrossrefPubMedGoogle Scholar
  • 13 Vicenzini E, Galloni L, Ricciardi M et al. Advantages and pitfalls of three-dimensional ultrasound imaging of carotid bifurcation. Eur Neurol 2011; 65: 309-316
    CrossrefPubMedGoogle Scholar
  • 14 North American Symptomatic Carotid Endarterectomy Trial collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991; 325: 445-453
    CrossrefPubMedGoogle Scholar
  • 15 Grouven U, Bender R, Ziegler A et al. Comparing methods of measurement. Dtsch med Wochenschr 2007; 132: e69-e73
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Widder B, Görtler M. Extrakranielle Duplexsonographie. In: Widder B, Görtler M, (eds.) Doppler- und Duplexsonographie der hirnversorgenden Arterien. Berlin, Heidelberg, New York: Springer: 2004: 167-190
    CrossrefGoogle Scholar
  • 17 Boussel L, Herigault G, de La Vega A et al. Swallowing, arterial pulsation and breathing induce motion artefacts in carotid artery MRI. J Magn Reson Imaging 2006; 23: 413-415
    CrossrefPubMedGoogle Scholar
  • 18 Arning C. Ultrasonographic criteria for diagnosing a dissection of the internal carotid artery. Ultraschall in Med 2005; 26: 24-28
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Topakian R, King A, Kwon SU et al. Ultrasonic plaque echolucency and emboli signals predict stroke in asymptomatic carotid stenosis. Neurology 2011; 77: 751-758
    CrossrefPubMedGoogle Scholar
  • 20 Piscaglia F, Nolsoe C, Dietrich CF et al. The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall in Med 2012; 33: 33-59
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 ter Haar G. Safety and bio-effects of ultrasound contrast agents. Med Biol Eng Comput 2009; 47: 893-900
    CrossrefPubMedGoogle Scholar
  • 22 Staub D, Patel MB, Tibrewala A et al. Vasa Vasorum and Plaque Neovascularization on Contrast-Enhanced Carotid Ultrasound Imaging Correlates With Cardiovascular Disease and Past Cardiovascular Events. Stroke 2009; 41: 41-47
    PubMedGoogle Scholar
  • 23 Herzberg M, Boy S, Hölscher T et al. Prehospital stroke diagnostics based on neurological examination and transcranial ultrasound. Crit Ultrasound J 2014; 6: 3
    CrossrefPubMedGoogle Scholar
  • 24 Ota H, Takase K, Rikimaru H et al. Quantitative vascular measurements in arterial occlusive disease. RadioGraphics 2005; 25: 1141-1158
    CrossrefPubMedGoogle Scholar
  • 25 Dodds S. The haemodynamics of asymmetric stenoses. Eur J Vasc Endovasc Surg 2002; 24: 332-337
    CrossrefPubMedGoogle Scholar
  • 26 Lewis RF, Abrahamowicz M, Cote R et al. Predictive power of duplex ultrasonography in asymptomatic carotid disease. Ann Intern Med 1997; 127: 13-20
    CrossrefPubMedGoogle Scholar
  • 27 Nabavi DG, Ringelstein EB, Faiss J et al. Regional and national stroke units in Germany. Amended certification criteria. Nervenarzt 2012; 83: 1039-1052
    CrossrefPubMedGoogle Scholar
  • 28 U-King-Im JM, Hollingworth W, Trivedi RA et al. Cost-effectiveness of diagnostic strategies prior to carotid endarterectomy. Ann Neurol 2005; 58: 506-515
    CrossrefPubMedGoogle Scholar
  • 29 Buskens E, Nederkoorn PJ, Buijs-Van Der Woude T et al. Imaging of carotid arteries in symptomatic patients: cost-effectiveness of diagnostic strategies. Radiology 2004; 233: 101-112
    CrossrefPubMedGoogle Scholar