Diagnostic accuracy and agreement of imaging modalities in the assessment of carotid artery stenosis
Mahmoud M Hassan, Abdelnaem M. Abdelnaem, Ahmed E. Mohamed, Abd E. ShokryBackground and aim
Accurate assessment of carotid artery stenosis is essential for guiding revascularization strategies and preventing ischemic stroke. While digital subtraction angiography (DSA) remains the gold standard, noninvasive imaging techniques such as carotid duplex ultrasound (DUS), magnetic resonance angiography (MRA), and computed tomography angiography (CTA) are widely used in clinical practice. This study aimed to evaluate the diagnostic accuracy and intramodality agreement of DUS, MRA, and CTA compared with DSA in grading carotid artery stenosis.
Patients and methods
A cross-sectional study included 30 Egyptian patients with carotid artery stenosis undergoing evaluation for carotid artery stenting; 20 were male, and 10 were female. All patients underwent carotid DUS and DSA, while MRA and CTA were performed when available. The degree of stenosis was classified according to NASCET criteria. Diagnostic performance metrics, including sensitivity, specificity, and agreement (kappa statistics), were analyzed, and comparisons between modalities were performed.
Results
Among 30 Egyptian patients aged 66.37±8.2 years, DSA identified severe stenosis in 66.7% and subtotal stenosis in 30% of patients. DUS tended to overestimate stenosis severity, classifying 76.7% of cases as severe and failing to detect subtotal occlusion (
Conclusion
DSA remains the reference standard for accurate grading of carotid artery stenosis. DUS is a useful screening tool, but may overestimate severity, while MRA tends to underestimate high-grade stenosis. CTA shows promising agreement but is limited by availability.