Imaging modality-dependent carotid stenosis severity variations against intravascular ultrasound as a reference: Carotid Artery intravasculaR Ultrasound Study (CARUS).

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS International Journal of Cardiovascular Imaging Pub Date : 2023-10-01 Epub Date: 2023-08-21 DOI:10.1007/s10554-023-02875-1

Lukasz Tekieli, Anna Kablak-Ziembicka, Wladyslaw Dabrowski, Karolina Dzierwa, Zbigniew Moczulski, Malgorzata Urbanczyk-Zawadzka, Adam Mazurek, Justyna Stefaniak, Piotr Paluszek, Maciej Krupinski, Tadeusz Przewlocki, Piotr Pieniazek, Piotr Musialek

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引用次数: 1

Abstract

Purpose: Different non-invasive and invasive imaging modalities are used to determine carotid artery stenosis severity that remains a principal parameter in clinical decision-making. We compared stenosis degree obtained with different modalities against vascular imaging gold standard, intravascular ultrasound, IVUS.

Methods: 300 consecutive patients (age 47-83 years, 192 men, 64% asymptomatic) with carotid artery stenosis of " ≥ 50%" referred for potential revascularization received as per study protocol (i) duplex ultrasound (DUS), (ii) computed tomography angiography (CTA), (iii) intraarterial quantitative angiography (iQA) and (iv) and (iv) IVUS. Correlation of measurements with IVUS (r), proportion of those concordant (within 10%) and proportion of under/overestimated were calculated along with recipient-operating-characteristics (ROC).

Results: For IVUS area stenosis (AS) and IVUS minimal lumen area (MLA), there was only a moderate correlation with DUS velocities (peak-systolic, PSV; end-diastolic, EDV; r values of 0.42-0.51, p < 0.001 for all). CTA systematically underestimated both reference area and MLA (80.4% and 92.3% cases) but CTA error was lesser for AS (proportion concordant-57.4%; CTA under/overestimation-12.5%/30.1%). iQA diameter stenosis (DS) was found concordant with IVUS in 41.1% measurements (iQA under/overestimation 7.9%/51.0%). By univariate model, PSV (ROC area-under-the-curve, AUC, 0.77, cutoff 2.6 m/s), EDV (AUC 0.72, cutoff 0.71 m/s) and CTA-DS (AUC 0.83, cutoff 59.6%) were predictors of ≥ 50% DS by IVUS (p < 0.001 for all). Best predictor, however, of ≥ 50% DS by IVUS was stenosis severity evaluation by automated contrast column density measurement on iQA (AUC 0.87, cutoff 68%, p < 0.001). Regarding non-invasive techniques, CTA was the only independent diagnostic modality against IVUS on multivariate model (p = 0.008).

Conclusion: IVUS validation shows significant imaging modality-dependent variations in carotid stenosis severity determination.

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影像学模式依赖性颈动脉狭窄严重程度的变化与血管内超声对照：颈动脉血管内超声研究（CARUS）。

目的：使用不同的无创和有创成像模式来确定颈动脉狭窄的严重程度，这仍然是临床决策的主要参数。我们将不同方式获得的狭窄程度与血管成像金标准、血管内超声、IVUS进行了比较。方法：连续300例患者（年龄47-83岁，192名男性，64%无症状）颈动脉狭窄 ≥ 50%”指根据研究方案接受的潜在血运重建（i）双相超声（DUS），（ii）计算机断层摄影血管造影术（CTA），（iii）动脉内定量血管造影学（iQA），（iv）和（iv）IVUS。测量值与IVUS的相关性（r），一致的比例（10%以内）以及低估/高估的比例与接受者的操作特征（ROC）一起计算。结果：对于IVUS面积狭窄（AS）和IVUS最小管腔面积（MLA），DUS速度（收缩峰值PSV；舒张末期EDV；r值0.42-0.51，p 结论：IVUS验证显示颈动脉狭窄严重程度的确定存在显著的成像模式依赖性变化。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Cardiovascular Imaging 医学-核医学

CiteScore

4.00

自引率

9.50%

发文量

审稿时长

1 months

期刊介绍： The International Journal of Cardiovascular Imaging publishes technical and clinical communications (original articles, review articles and editorial comments) associated with cardiovascular diseases. The technical communications include the research, development and evaluation of novel imaging methods in the various imaging domains. These domains include magnetic resonance imaging, computed tomography, X-ray imaging, intravascular imaging, and applications in nuclear cardiology and echocardiography, and any combination of these techniques. Of particular interest are topics in medical image processing and image-guided interventions. Clinical applications of such imaging techniques include improved diagnostic approaches, treatment , prognosis and follow-up of cardiovascular patients. Topics include: multi-center or larger individual studies dealing with risk stratification and imaging utilization, applications for better characterization of cardiovascular diseases, and assessment of the efficacy of new drugs and interventional devices.