Validation of Multiparametric Ultrasonography Criteria with Digital Subtraction Angiography in Carotid Artery Disease

A Prospective Multicenter Study

Kristian Barlinn, Henning Rickmann, Hagen Kitzler, Christos Krogias, Henning Strohm, Andrij Abramyuk, Jessica Barlinn, Timo Siepmann, Ali Rabahi, Xina Graehlert, Uta Schwanebeck, Simon Winzer, Sebastian Arnold, Peter Moennings, Lars Peder Pallesen, Ulf Bodechtel, Harald Mudra, Jennifer Linn, Heinz Reichmann, Andrei Alexandrov & 3 others Georg Gahn, Norbert Weiss, Volker Puetz

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose The German Society of Ultrasound in Medicine (DEGUM) recently revised its multiparametric criteria for duplex ultrasonography (DUS) grading of internal carotid artery (ICA) disease. We determined the diagnostic accuracy of the revised DEGUM criteria for ultrasonography grading of ICA disease in a prospective multicenter study. Materials and Methods We evaluated consecutive patients who underwent digital subtraction angiography of the extracranial carotid arteries at four tertiary care hospitals. Blinded investigators graded ICA disease according to DEGUM-recommended ultrasonography criteria and calculated NASCET-type percent stenosis from angiography images. Endpoints included overall classification accuracy, prediction of clinically relevant disease categories and between-test agreement in the continuous range of percent stenosis. Results A total of 121 patients (median age: 69 [IQR, 16] years; 74% men; median time between DUS and angiography: 1 day [IQR, 2]) provided 163 DUS-angiography carotid artery pairs. The classification accuracy of the DEGUM criteria to predict stenosis within 10% increments as compared to angiography was 34.9% (95% CI, 28.0-42.6). The sensitivity of DUS for the detection of moderate (50-69%) and severe (70-99%) stenosis was 35% and 81%, with an overall accuracy of 73% and 74%, respectively. The specificity was 89% and 69%, respectively. Considering the continuous spectrum of the disease (0-100%), the Bland-Altman interval limit of agreement was 51%. Conclusion At laboratories experienced with ultrasound grading of the extracranial ICA, the revised DEGUM multiparametric ultrasonography criteria do not eliminate the need for a confirmatory test for the identification of clinically relevant grades of the disease.

Original languageEnglish (US)
Pages (from-to)535-543
Number of pages9
JournalUltraschall in der Medizin
Volume39
Issue number5
DOIs
StatePublished - May 24 2018

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Carotid Artery Diseases
Digital Subtraction Angiography
Multicenter Studies
Ultrasonography
Prospective Studies
Angiography
Pathologic Constriction
Carotid Arteries
Internal Carotid Artery
Tertiary Healthcare
Tertiary Care Centers
Research Personnel
Medicine

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

Validation of Multiparametric Ultrasonography Criteria with Digital Subtraction Angiography in Carotid Artery Disease : A Prospective Multicenter Study. / Barlinn, Kristian; Rickmann, Henning; Kitzler, Hagen; Krogias, Christos; Strohm, Henning; Abramyuk, Andrij; Barlinn, Jessica; Siepmann, Timo; Rabahi, Ali; Graehlert, Xina; Schwanebeck, Uta; Winzer, Simon; Arnold, Sebastian; Moennings, Peter; Pallesen, Lars Peder; Bodechtel, Ulf; Mudra, Harald; Linn, Jennifer; Reichmann, Heinz; Alexandrov, Andrei; Gahn, Georg; Weiss, Norbert; Puetz, Volker.

In: Ultraschall in der Medizin, Vol. 39, No. 5, 24.05.2018, p. 535-543.

Research output: Contribution to journalArticle

Barlinn, K, Rickmann, H, Kitzler, H, Krogias, C, Strohm, H, Abramyuk, A, Barlinn, J, Siepmann, T, Rabahi, A, Graehlert, X, Schwanebeck, U, Winzer, S, Arnold, S, Moennings, P, Pallesen, LP, Bodechtel, U, Mudra, H, Linn, J, Reichmann, H, Alexandrov, A, Gahn, G, Weiss, N & Puetz, V 2018, 'Validation of Multiparametric Ultrasonography Criteria with Digital Subtraction Angiography in Carotid Artery Disease: A Prospective Multicenter Study', Ultraschall in der Medizin, vol. 39, no. 5, pp. 535-543. https://doi.org/10.1055/s-0043-119355
Barlinn, Kristian ; Rickmann, Henning ; Kitzler, Hagen ; Krogias, Christos ; Strohm, Henning ; Abramyuk, Andrij ; Barlinn, Jessica ; Siepmann, Timo ; Rabahi, Ali ; Graehlert, Xina ; Schwanebeck, Uta ; Winzer, Simon ; Arnold, Sebastian ; Moennings, Peter ; Pallesen, Lars Peder ; Bodechtel, Ulf ; Mudra, Harald ; Linn, Jennifer ; Reichmann, Heinz ; Alexandrov, Andrei ; Gahn, Georg ; Weiss, Norbert ; Puetz, Volker. / Validation of Multiparametric Ultrasonography Criteria with Digital Subtraction Angiography in Carotid Artery Disease : A Prospective Multicenter Study. In: Ultraschall in der Medizin. 2018 ; Vol. 39, No. 5. pp. 535-543.
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abstract = "Purpose The German Society of Ultrasound in Medicine (DEGUM) recently revised its multiparametric criteria for duplex ultrasonography (DUS) grading of internal carotid artery (ICA) disease. We determined the diagnostic accuracy of the revised DEGUM criteria for ultrasonography grading of ICA disease in a prospective multicenter study. Materials and Methods We evaluated consecutive patients who underwent digital subtraction angiography of the extracranial carotid arteries at four tertiary care hospitals. Blinded investigators graded ICA disease according to DEGUM-recommended ultrasonography criteria and calculated NASCET-type percent stenosis from angiography images. Endpoints included overall classification accuracy, prediction of clinically relevant disease categories and between-test agreement in the continuous range of percent stenosis. Results A total of 121 patients (median age: 69 [IQR, 16] years; 74{\%} men; median time between DUS and angiography: 1 day [IQR, 2]) provided 163 DUS-angiography carotid artery pairs. The classification accuracy of the DEGUM criteria to predict stenosis within 10{\%} increments as compared to angiography was 34.9{\%} (95{\%} CI, 28.0-42.6). The sensitivity of DUS for the detection of moderate (50-69{\%}) and severe (70-99{\%}) stenosis was 35{\%} and 81{\%}, with an overall accuracy of 73{\%} and 74{\%}, respectively. The specificity was 89{\%} and 69{\%}, respectively. Considering the continuous spectrum of the disease (0-100{\%}), the Bland-Altman interval limit of agreement was 51{\%}. Conclusion At laboratories experienced with ultrasound grading of the extracranial ICA, the revised DEGUM multiparametric ultrasonography criteria do not eliminate the need for a confirmatory test for the identification of clinically relevant grades of the disease.",
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T2 - A Prospective Multicenter Study

AU - Barlinn, Kristian

AU - Rickmann, Henning

AU - Kitzler, Hagen

AU - Krogias, Christos

AU - Strohm, Henning

AU - Abramyuk, Andrij

AU - Barlinn, Jessica

AU - Siepmann, Timo

AU - Rabahi, Ali

AU - Graehlert, Xina

AU - Schwanebeck, Uta

AU - Winzer, Simon

AU - Arnold, Sebastian

AU - Moennings, Peter

AU - Pallesen, Lars Peder

AU - Bodechtel, Ulf

AU - Mudra, Harald

AU - Linn, Jennifer

AU - Reichmann, Heinz

AU - Alexandrov, Andrei

AU - Gahn, Georg

AU - Weiss, Norbert

AU - Puetz, Volker

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Y1 - 2018/5/24

N2 - Purpose The German Society of Ultrasound in Medicine (DEGUM) recently revised its multiparametric criteria for duplex ultrasonography (DUS) grading of internal carotid artery (ICA) disease. We determined the diagnostic accuracy of the revised DEGUM criteria for ultrasonography grading of ICA disease in a prospective multicenter study. Materials and Methods We evaluated consecutive patients who underwent digital subtraction angiography of the extracranial carotid arteries at four tertiary care hospitals. Blinded investigators graded ICA disease according to DEGUM-recommended ultrasonography criteria and calculated NASCET-type percent stenosis from angiography images. Endpoints included overall classification accuracy, prediction of clinically relevant disease categories and between-test agreement in the continuous range of percent stenosis. Results A total of 121 patients (median age: 69 [IQR, 16] years; 74% men; median time between DUS and angiography: 1 day [IQR, 2]) provided 163 DUS-angiography carotid artery pairs. The classification accuracy of the DEGUM criteria to predict stenosis within 10% increments as compared to angiography was 34.9% (95% CI, 28.0-42.6). The sensitivity of DUS for the detection of moderate (50-69%) and severe (70-99%) stenosis was 35% and 81%, with an overall accuracy of 73% and 74%, respectively. The specificity was 89% and 69%, respectively. Considering the continuous spectrum of the disease (0-100%), the Bland-Altman interval limit of agreement was 51%. Conclusion At laboratories experienced with ultrasound grading of the extracranial ICA, the revised DEGUM multiparametric ultrasonography criteria do not eliminate the need for a confirmatory test for the identification of clinically relevant grades of the disease.

AB - Purpose The German Society of Ultrasound in Medicine (DEGUM) recently revised its multiparametric criteria for duplex ultrasonography (DUS) grading of internal carotid artery (ICA) disease. We determined the diagnostic accuracy of the revised DEGUM criteria for ultrasonography grading of ICA disease in a prospective multicenter study. Materials and Methods We evaluated consecutive patients who underwent digital subtraction angiography of the extracranial carotid arteries at four tertiary care hospitals. Blinded investigators graded ICA disease according to DEGUM-recommended ultrasonography criteria and calculated NASCET-type percent stenosis from angiography images. Endpoints included overall classification accuracy, prediction of clinically relevant disease categories and between-test agreement in the continuous range of percent stenosis. Results A total of 121 patients (median age: 69 [IQR, 16] years; 74% men; median time between DUS and angiography: 1 day [IQR, 2]) provided 163 DUS-angiography carotid artery pairs. The classification accuracy of the DEGUM criteria to predict stenosis within 10% increments as compared to angiography was 34.9% (95% CI, 28.0-42.6). The sensitivity of DUS for the detection of moderate (50-69%) and severe (70-99%) stenosis was 35% and 81%, with an overall accuracy of 73% and 74%, respectively. The specificity was 89% and 69%, respectively. Considering the continuous spectrum of the disease (0-100%), the Bland-Altman interval limit of agreement was 51%. Conclusion At laboratories experienced with ultrasound grading of the extracranial ICA, the revised DEGUM multiparametric ultrasonography criteria do not eliminate the need for a confirmatory test for the identification of clinically relevant grades of the disease.

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