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Power Doppler Imaging: Initial Evaluation as a Screening Examination for Carotid Artery Stenosis¹

¹ From the Dept of Radiology, Ochsner Foundation Hosp, 1514 Jefferson Hwy, New Orleans, LA 70121-2484 (E.I.B., L.A.T., L.A.K., M.A.S., D.H.S.); Research Dept, American College of Radiology, Reston, Va (J.H.S., P.E.C., J.H.B.); Dept of Radiology, The Western Pennsylvania Hosp, Pittsburgh (J.B.L., H.L.N.); Dept of Family and Community Medicine, Medical College of Wisconsin, Milwaukee (C.A.B.); and Dept of Medicine, Palo Alto VA Health Care System, Stanford Univ, Calif (P.A.H.). Received Jun 7, 1999; revision requested Aug 9; revision received Oct 11; accepted Nov 10. Supported in part by the American College of Radiology and in-kind contributions from Ochsner Foundation Hosp, The Western Pennsylvania Hosp, and the American College of Radiology. Address correspondence to E.I.B.

PURPOSE: To evaluate power Doppler imaging as a possible screening examination for carotid artery stenosis.

MATERIALS AND METHODS: In the principal pilot study, a prospective, blinded comparison of power Doppler imaging with duplex Doppler imaging, the reference-standard method, was conducted in 100 consecutive patients routinely referred for carotid artery imaging at a large, private multispecialty clinic. In the validation pilot study, a prospective, blinded comparison of power Doppler imaging with digital subtraction angiography, the reference-standard method, was conducted in 20 consecutive patients routinely referred at a teaching hospital. Using conservative assumptions, the authors performed cost-effectiveness analysis.

RESULTS: Power Doppler imaging produced diagnostic-quality images in 89% of patients. When the images of the patients with nondiagnostic examinations were regarded as positive, power Doppler imaging had an area under the receiver operating characteristic curve, A_z, of 0.87, sensitivity of 70%, and specificity of 91%. The validation study results were very similar. The cost-effectiveness of screening and, as indicated, duplex Doppler imaging as the definitive diagnostic examination and endarterectomy was $47,000 per quality-adjusted life-year.

CONCLUSION: The A_z value for power Doppler imaging compares well with that for mammography, a generally accepted screening examination, and with most other imaging examinations. Power Doppler imaging is likely to be a reasonably accurate and cost-effective screening examination for carotid artery stenosis in asymptomatic populations.

Index terms: Carotid arteries, angiography, 172.1248, 908.122 • Carotid arteries, stenosis or obstruction, 172.721, 908.721 • Carotid arteries, US, 172.12983, 172.12984, 172.12989 • Ultrasound (US), Doppler studies, 172.12983, 172.12984, 172.12989 • Ultrasound (US), power Doppler studies, 172.12989

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