The Comparison between Digital Subtraction Angiography, CT Angiography, and Doppler Ultrasonography in Evaluation and Assessment of Carotid Artery Stenosis

Abstract

Background: Common angiography or digital subtraction angiography (DSA) is the gold standard protocol for diagnosis of carotid artery stenosis. However, this method has very high delivered X-ray doses to patient and personnel as an invasive diagnostic protocol. The progress of noninvasive or minimally invasive diagnostic techniques like Doppler ultrasonography (DUS), CT angiography (CTA), and MR angiography (MRA) has improved the detection and evaluation of stenosis lesions. The aim of this study was to evaluate the usefulness and accuracy of non-invasive DUS and CTA, attempting in this way to restrict DSA only for final proof of high-grade stenosis. Methods: 25 male patients with carotid artery stenosis were examined with CTA, DUS, and DSA. The lumen diameter of carotid artery was measured and compared with CTA and DUS. The results of CTA and DUS were compared and correlated with DSA results as a reference. Results: Data of lumen diameter measurements in ultrasonography and CTA (for internal and common carotid artery) showed no significant differences between the two methods. Mean internal/common lumen artery in stenosis region was 3.745/5.114 and 3.643/5.000 millimeters for CTA and DUS, respectively. The results (mean ± standard deviation) of moderate to severe carotid stenosis obtained from CTA, DUS, and DSA in stenoses ≥ 50% were 67.8 ± 10.82, 65.6 ± 13.25, and 71.2 ± 11.2 (in percentage), respectively. The Spearman correlations of CTA and DUS results with DSA results were 0.865 and 0.812, respectively. Conclusions: Significant correlations were found in our study between CTA/DSA and DUS/DSA. We showed that the accuracy of CTA and Doppler ultrasonography was appropriate in comparison with DSA results for male patients with carotid stenosis ≥ 50%. We also showed that measurement of PSV could be a good parameter for evaluating carotid stenosis like PSVr in Doppler ultrasonography.