Grading of carotid artery stenosis with computed tomography angiography: whether to use the narrowest diameter or the cross-sectional area
Abstract Objectives To compare the estimation of carotid artery stenosis by computed tomography angiography (CTA) based on cross-sectional area versus the smallest diameter measurement, and test the accuracy of both CTA measurements using color Doppler ultrasonography (CDUS) as a reference method. M...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2018-05-01
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| Series: | Insights into Imaging |
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| Online Access: | http://link.springer.com/article/10.1007/s13244-018-0622-5 |
| _version_ | 1811287917469892608 |
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| author | Kristina Samarzija Petar Milosevic Zoran Jurjevic Emilija Erdeljac |
| author_facet | Kristina Samarzija Petar Milosevic Zoran Jurjevic Emilija Erdeljac |
| author_sort | Kristina Samarzija |
| collection | DOAJ |
| description | Abstract Objectives To compare the estimation of carotid artery stenosis by computed tomography angiography (CTA) based on cross-sectional area versus the smallest diameter measurement, and test the accuracy of both CTA measurements using color Doppler ultrasonography (CDUS) as a reference method. Methods For 113 carotid arteries with stenosis ≥50% we analysed the differences in the estimated stenosis level between both CTA methods and CDUS using the Bland-Altman approach. Further, we calculated sensitivity, specificity and plotted receiver operating characteristic (ROC) curves for both CTA methods. Results The mean difference between CDUS and CTA (area) measurements was −0.4% (p = 0.68); between CDUS and CTA (diameter), 20.7% (p < 0.001); and between CTA (area) and CTA (diameter), 21.2% (p < 0.001). Sensitivity and specificity for the CTA (area) method were 81% and 77%, and for CTA (diameter) were 23% and 100%. The area under the curve (AUC) for CTA (diameter) was 0.62 (0.57, 0.66), and for CTA (area) 0.79 (0.71–0.87). The equality test for the two AUCs was <0.0001. Conclusions CTA (diameter)-based measurements significantly underestimated the degree of carotid stenosis. We recommend the CTA (area) method because of its higher predictive power for a correct stenosis classification and a lack of significant difference in the estimated stenosis level, compared to CDUS. Main messages • Cross-sectional area measurement considers asymmetric shape of the residual vessel lumen. • CTA (diameter) method on average significantly underestimates the true level of stenosis. • CTA (area) method correctly classifies vessels needing surgical intervention. |
| first_indexed | 2024-04-13T03:26:55Z |
| format | Article |
| id | doaj.art-15435b4de6dd4064abfb36500d5c9c08 |
| institution | Directory Open Access Journal |
| issn | 1869-4101 |
| language | English |
| last_indexed | 2024-04-13T03:26:55Z |
| publishDate | 2018-05-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Insights into Imaging |
| spelling | doaj.art-15435b4de6dd4064abfb36500d5c9c082022-12-22T03:04:37ZengSpringerOpenInsights into Imaging1869-41012018-05-019452753410.1007/s13244-018-0622-5Grading of carotid artery stenosis with computed tomography angiography: whether to use the narrowest diameter or the cross-sectional areaKristina Samarzija0Petar Milosevic1Zoran Jurjevic2Emilija Erdeljac3Department of Radiology, General Hospital KarlovacDepartment of Vascular Surgery, General Hospital KarlovacDepartment of Radiology, General Hospital KarlovacDepartment of Neurology, General Hospital KarlovacAbstract Objectives To compare the estimation of carotid artery stenosis by computed tomography angiography (CTA) based on cross-sectional area versus the smallest diameter measurement, and test the accuracy of both CTA measurements using color Doppler ultrasonography (CDUS) as a reference method. Methods For 113 carotid arteries with stenosis ≥50% we analysed the differences in the estimated stenosis level between both CTA methods and CDUS using the Bland-Altman approach. Further, we calculated sensitivity, specificity and plotted receiver operating characteristic (ROC) curves for both CTA methods. Results The mean difference between CDUS and CTA (area) measurements was −0.4% (p = 0.68); between CDUS and CTA (diameter), 20.7% (p < 0.001); and between CTA (area) and CTA (diameter), 21.2% (p < 0.001). Sensitivity and specificity for the CTA (area) method were 81% and 77%, and for CTA (diameter) were 23% and 100%. The area under the curve (AUC) for CTA (diameter) was 0.62 (0.57, 0.66), and for CTA (area) 0.79 (0.71–0.87). The equality test for the two AUCs was <0.0001. Conclusions CTA (diameter)-based measurements significantly underestimated the degree of carotid stenosis. We recommend the CTA (area) method because of its higher predictive power for a correct stenosis classification and a lack of significant difference in the estimated stenosis level, compared to CDUS. Main messages • Cross-sectional area measurement considers asymmetric shape of the residual vessel lumen. • CTA (diameter) method on average significantly underestimates the true level of stenosis. • CTA (area) method correctly classifies vessels needing surgical intervention.http://link.springer.com/article/10.1007/s13244-018-0622-5Carotid artery stenosisCT angiographyColor Doppler ultrasonographyAtherosclerosisMedical imaging |
| spellingShingle | Kristina Samarzija Petar Milosevic Zoran Jurjevic Emilija Erdeljac Grading of carotid artery stenosis with computed tomography angiography: whether to use the narrowest diameter or the cross-sectional area Insights into Imaging Carotid artery stenosis CT angiography Color Doppler ultrasonography Atherosclerosis Medical imaging |
| title | Grading of carotid artery stenosis with computed tomography angiography: whether to use the narrowest diameter or the cross-sectional area |
| title_full | Grading of carotid artery stenosis with computed tomography angiography: whether to use the narrowest diameter or the cross-sectional area |
| title_fullStr | Grading of carotid artery stenosis with computed tomography angiography: whether to use the narrowest diameter or the cross-sectional area |
| title_full_unstemmed | Grading of carotid artery stenosis with computed tomography angiography: whether to use the narrowest diameter or the cross-sectional area |
| title_short | Grading of carotid artery stenosis with computed tomography angiography: whether to use the narrowest diameter or the cross-sectional area |
| title_sort | grading of carotid artery stenosis with computed tomography angiography whether to use the narrowest diameter or the cross sectional area |
| topic | Carotid artery stenosis CT angiography Color Doppler ultrasonography Atherosclerosis Medical imaging |
| url | http://link.springer.com/article/10.1007/s13244-018-0622-5 |
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