Evaluation of the interrater and intermethod agreement of the German multiparametric ultrasound criteria for the grading
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DIAGNOSTIC NEURORADIOLOGY
Evaluation of the interrater and intermethod agreement of the German multiparametric ultrasound criteria for the grading of internal carotid artery stenosis Cindy Richter 1 & Anna Weinreich 2 & Simone Mucha 1 & Dorothee Saur 3 & Johann Otto Pelz 3 Received: 22 June 2020 / Accepted: 31 August 2020 # The Author(s) 2020
Abstract Purpose The interdisciplinary German guidelines for the diagnosis and treatment of internal carotid artery stenosis (ICAS) recommend a multiparametric approach for the sonographic grading of extracranial ICAS. The aim of this study is to evaluate the interrater and intermethod agreement of this elaborated sonographic approach with different angiographic modalities. Methods Patients with extracranial ICAS were examined twice with colour-coded duplex sonography (CDS) by two experienced vascular neurologists. Each of the ten criteria and the resulting stenotic value were assessed. Grading of ICAS based on the multiparametric ultrasound criteria was compared with different angiography modalities (magnetic resonance angiography (MRA), computed tomography angiography (CTA), digital subtraction angiography (DSA)). Results Seventy-four consecutive patients with 91 extracranial ICAS were recruited from our stroke unit and neurovascular outpatient clinic. Interrater agreement for each single ultrasound criterion ranged from moderate to excellent (for the peak systolic velocity). Concerning the absolute stenotic value of ICAS, an excellent agreement between both ultrasound examiners with an ICC of 0.91 (range 0.87–0.94; p < 0.001) was found. In 96% of ICAS, the difference between the stenotic values was ≤ 10%. Intermethod agreements between CDS and DSA, CTA, and MRA were also good for both sonographers. Conclusion Strictly adhering to the multiparametric “DEGUM ultrasound criteria”, we found an excellent interrater agreement and a good intermethod agreement compared with angiography for the sonographic grading of extracranial ICAS. Thus, multiparametric CDS is in particular suitable for the follow up of extracranial ICAS even when examinations are done by different sonographers. Keywords Ultrasound . Carotid artery disease . Interrater and intermethod agreement . Grading of internal carotid artery stenosis . DEGUM ultrasound criteria
Introduction Since patients with an at least moderate (≥ 50% distal diameter reduction percentage according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) [1]) CR and AW contributed equally * Johann Otto Pelz [email protected] 1
Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
2
Epilepsy-Center Berlin-Brandenburg, Berlin, Germany
3
Department of Neurology, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
symptomatic extracranial internal carotid artery stenosis (ICAS) harbour a substantially increased risk of early ischemic stroke recurrence after the index event [2], the early identification and correct grading of extracranial ICAS is of utmost import
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