Comparison of ultrasonography, CT angiography, and digital subtraction angiography in severe carotid stenoses.

Digital subtraction angiography (DSA) is considered to be the 'gold standard' for confirmation of severe (70-99%) stenoses of internal carotid arteries (ICAs). However, it is associated with a risk of complications. The aim of this study was to assess the accuracy of ultrasonography (US), computed tomographic angiography (CTA), and their combined use for the detection and quantification of severe carotid stenoses, when compared with DSA. Severe ICA stenoses were diagnosed by US in a set of 29 patients. All patients also underwent CTA and DSA. Sensitivity, specificity, positive (PPV), negative predictive values (NPV), and Pearson's correlation coefficient were used in the evaluation of the percentage of stenosis results. Homogeneity chi2 test was applied when assessing statistical significance. Severe stenosis was diagnosed in 34 ICAs. Two ICAs with uninterpretable CTA finding were excluded. The number of ICAs with stenoses 70-99%/<70%- US 32/0; CTA 29/3; US + CTA 29/3; DSA 24/8. Pearson's correlation coefficient - US 0.601; CTA 0.725; US + CTA 0.773. Sensitivity/specificity/PPV/NPV - US 1.0/0.75/0.75/xxx; CTA 1.0/0.844/0.828/1.0; US + CTA 1.0/0.844/0.828/1.0. Homogeneity chi2 test results - US, P = 0.002; CTA, P = 0.098; US + CTAG, P = 0.098. US in combination with CTA can be used for relatively secure diagnostics of severe ICA stenoses. Thus, invasive DSA can be avoided in a substantial number of patients.