Abstract
BackgroundCurrently, colour-coded duplex sonography (2D-CDS) is clinical standard for detection and grading of internal carotid artery stenosis (ICAS). However, unlike angiographic imaging modalities, 2D-CDS assesses ICAS by its hemodynamic effects rather than luminal changes. Aim of this study was to evaluate freehand 3D ultrasound (3DUS) for direct visualisation and quantification of ICAS.MethodsThirty-seven patients with 43 ICAS were examined with 2D-CDS as reference standard and with freehand B-mode respectively power-mode 3DUS. Stenotic value of 3D reconstructed ICAS was calculated as distal diameter respectively distal cross-sectional area (CSA) reduction percentage and compared with 2D-CDS.ResultsThere was a trend but no significant difference in successful 3D reconstruction of ICAS between B-mode and power mode (examiner 1 {Ex1} 81% versus 93%, examiner 2 {Ex2} 84% versus 88%). Inter-rater agreement was best for power-mode 3DUS and assessment of stenotic value as distal CSA reduction percentage (intraclass correlation coefficient {ICC} 0.90) followed by power-mode 3DUS and distal diameter reduction percentage (ICC 0.81). Inter-rater agreement was poor for B-mode 3DUS (ICC, distal CSA reduction 0.36, distal diameter reduction 0.51). Intra-rater agreement for power-mode 3DUS was good for both measuring methods (ICC, distal CSA reduction 0.88 {Ex1} and 0.78 {Ex2}; ICC, distal diameter reduction 0.83 {Ex1} and 0.76 {Ex2}). In comparison to 2D-CDS inter-method agreement was good and clearly better for power-mode 3DUS (ICC, distal diameter reduction percentage: Ex1 0.85, Ex2 0.78; distal CSA reduction percentage: Ex1 0.63, Ex2 0.57) than for B-mode 3DUS (ICC, distal diameter reduction percentage: Ex1 0.40, Ex2 0.52; distal CSA reduction percentage: Ex1 0.15, Ex2 0.51).ConclusionsNon-invasive power-mode 3DUS is superior to B-mode 3DUS for imaging and quantification of ICAS. Thereby, further studies are warranted which should now compare power-mode 3DUS with the angiographic gold standard imaging modalities for quantification of ICAS, i.e. with CTA or CE-MRA.
Highlights
Worldwide, ischemic stroke is among the leading causes for disability, mortality and of great socio-economic importance [1, 2]
Non-invasive power-mode 3D ultrasound (3DUS) is superior to B-mode 3DUS for imaging and quantification of internal carotid artery stenosis (ICAS)
A great advantage of 3DUS compared to Digital subtraction angiography (DSA) is that 3DUS allows assessment of ICAS as both diameter and cross-sectional area (CSA) reduction with the latter being independent from the chosen projection view
Summary
Ischemic stroke is among the leading causes for disability, mortality and of great socio-economic importance [1, 2]. Three-dimensional ultrasound (3DUS) which is nowadays already routinely used in obstetrics [7] has the potential to visualise extracranial brain-supplying arteries similar to CTA or MRA and might ideally complement 2D-CDS which grades ICAS by predominantly assessing hemodynamic parameters [8, 9]. There are still unsolved questions that might hamper translation of vascular 3DUS from bench to clinical routine It is unclear which ultrasound mode should be the basis for 3DUS, e.g. 3DUS based on high-resolution native B-mode ultrasound [11, 16, 18] or 3DUS based on power mode [10, 12, 14, 15, 17]. Aim of this study was to evaluate freehand 3D ultrasound (3DUS) for direct visualisation and quantification of ICAS
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