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Noninvasive Vascular Diagnosis pp 255–262Cite as

Carotid Duplex Consensus Criteria on Interpretation of Carotid Duplex Ultrasound

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Abstract

Clinicians have relied on published institutional experience for interpreting carotid duplex ultrasound studies. We conducted a study where we analyzed 376 carotid arteries to validate the ultrasound imaging consensus criteria published in 2003. We used receiver operating curves (ROC) to compare peak systolic velocities (PSV), end-diastolic velocities (EDV) of the internal carotid artery (ICA), and ICA/common carotid ratios in detecting <50%, 50–69% (ICA PSV of 125–230 cm/s), and 70–99% (PSV of ≥230 cm/s) stenosis according to the consensus criteria. The consensus criteria uses a PSV of 125–230 cm/s for detecting angiographic stenosis of 50–69%, which had 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 than EDV or ICA/CCA ratio (p = 0.036) in detecting ≥70% stenosis and ≥50% stenosis. The consensus criteria for diagnosing 50–69% stenosis can be significantly improved by using an ICA PSV of 140–230 cm/s, with a sensitivity of 94%, a specificity of 92%, and an overall accuracy of 92%. We concluded that the consensus criteria can be accurately used for diagnosing ≥70% stenosis; however, the accuracy can be improved for detecting 50–69% stenosis if the ICA PSV is changed to 140 to <230 cm/s.

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Author information

Authors and Affiliations

  1. Department of Surgery, Division of Vascular/Endovascular Surgery, West Virginia University/Charleston Division, 3110 MacCorkle Ave., SE, Charleston, WV, 25304, USA

    Ali F. AbuRahma MD

Authors
  1. Ali F. AbuRahma MD
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Correspondence to Ali F. AbuRahma MD .

Editor information

Editors and Affiliations

  1. Charleston, West Virginia, USA

    Ali F. AbuRahma

Review Questions

Review Questions

  1. 1.

    The original carotid duplex consensus criteria recommended the following velocities for detecting ≥70 to 99% internal carotid artery stenosis:

    1. a.

      An internal carotid artery PSV of ≥230 cm/s

    2. b.

      An internal carotid artery PSV of ≥200 cm/s

    3. c.

      An internal carotid artery PSV of ≥150 cm/s

    4. d.

      An internal carotid artery PSV of ≥300 cm/s

  2. 2.

    The original carotid duplex consensus criteria recommended that a PSV of ≥230 cm/s preferably be combined with the following:

    1. a.

      An internal carotid artery EDV of ≥70 cm/s

    2. b.

      An internal carotid artery EDV of >100 cm/s

    3. c.

      An internal carotid artery EDV of ≥140 cm/s

    4. d.

      An internal carotid artery EDV of ≥150 cm/s

  3. 3.

    The carotid duplex consensus criteria recommended the following ratios to be combined with a PSV of >230 cm/s, if needed:

    1. a.

      ICA/CCA ratio of >2

    2. b.

      ICA/CCA ratio of >3

    3. c.

      ICA/CCA ratio of >4

    4. d.

      ICA/CCA ratio of >5

  4. 4.

    This carotid duplex consensus criteria validation study showed the following:

    1. a.

      A PSV of the internal carotid artery of ≥230 cm/s was the best predictor of ≥70 to 99% stenosis.

    2. b.

      A PSV of the internal carotid artery of >140 to <230 cm/s was a better predictor for detecting 50 to <70% stenosis.

    3. c.

      A PSV of the internal carotid artery of >230 cm/s was a better predictor than the EDV of 100 or a ratio of >4.

    4. d.

      All of the above.

Answer Key

  1. 1.

    a

  2. 2.

    b

  3. 3.

    c

  4. 4.

    d

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AbuRahma, A.F. (2017). Carotid Duplex Consensus Criteria on Interpretation of Carotid Duplex Ultrasound. In: AbuRahma, A. (eds) Noninvasive Vascular Diagnosis. Springer, Cham. https://doi.org/10.1007/978-3-319-54760-2_19

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  • DOI: https://doi.org/10.1007/978-3-319-54760-2_19

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-54758-9

  • Online ISBN: 978-3-319-54760-2

  • eBook Packages: MedicineMedicine (R0)

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