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Published online before print September 18, 2003, 10.1148/radiol.2292030516

(Radiology 2003;229:340.)

A more recent version of this article appeared on November 1, 2003
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© RSNA, 2003

Special Reports

Carotid Artery Stenosis: Gray-Scale and Doppler US Diagnosis—Society of Radiologists in Ultrasound Consensus Conference1

Edward G. Grant, MD, Carol B. Benson, MD, Gregory L. Moneta, MD, Andrei V. Alexandrov, MD, RVT, J. Dennis Baker, MD, Edward I. Bluth, MD, Barbara A. Carroll, MD, Michael Eliasziw, PhD, John Gocke, MD, MPH, RVT, Barbara S. Hertzberg, MD, Sandra Katanick, RN, RVT, Laurence Needleman, MD, John Pellerito, MD, Joseph F. Polak, MD, Kenneth S. Rholl, MD, Douglas L. Wooster, MD, RVT and Eugene Zierler, MD

1 From the Dept of Radiology, Univ of Southern California, Keck School of Medicine, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033 (E.G.G.); Dept of Radiology, Brigham and Women’s Hosp, Harvard Med School, Boston, Mass (C.B.B., J.F.F.); Dept of Surgery, Oregon Health and Science Univ, Portland, Ore (G.L.M.); Cerebrovascular Ultrasound and Stroke Treatment Team, Univ of Texas Houston Med School (A.V.A.); Dept of Surgery, West Los Angeles VA Med Ctr, Calif (J.D.B.); Dept of Radiology, Ochsner Clinic, New Orleans, La (E.I.B.); Dept of Radiology, Duke Univ Med School, Durham, NC (B.A.C., B.S.H.); Dept of Biostatistics, Univ of Calgary, Alberta, Canada (M.E.); Midwest Heart Specialists Vascular Lab and La Grange Memorial Vascular Laboratory, Downers Grove, Ill (J.G.); Intersocietal Accreditation Commission, Columbia, Md (S.K.); Dept of Radiology, Thomas Jefferson Univ, Philadelphia, Pa (L.N.); Dept of Radiology, North Shore Univ Hosp, New York Univ School of Med, NY (J.P.); Dept of Radiology, Inova Alexandria Hosp, Va (K.S.R.); Dept of Surgery, Univ of Toronto, Ontario, Canada (D.L.W.); and Dept of Surgery, Univ of Washington Med School, Seattle (R.E.Z.). Received Apr 1, 2003; revision requested May 7; revision received May 21; accepted May 22. Address correspondence to E.G.G. (e-mail: edgrant@usc.edu).

The Society of Radiologists in Ultrasound convened a multidisciplinary panel of experts in the field of vascular ultrasonography (US) to come to a consensus regarding Doppler US for assistance in the diagnosis of carotid artery stenosis. The panel’s consensus statement is believed to represent a reasonable position on the basis of analysis of available literature and panelists’ experience. Key elements of the statement include the following: (a) All internal carotid artery (ICA) examinations should be performed with gray-scale, color Doppler, and spectral Doppler US. (b) The degree of stenosis determined at gray-scale and Doppler US should be stratified into the categories of normal (no stenosis), <50% stenosis, 50%–69% stenosis, >=70% stenosis to near occlusion, near occlusion, and total occlusion. (c) ICA peak systolic velocity (PSV) and presence of plaque on gray-scale and/or color Doppler images are primarily used in diagnosis and grading of ICA stenosis; two additional parameters, ICA-to–common carotid artery PSV ratio and ICA end-diastolic velocity may also be used when clinical or technical factors raise concern that ICA PSV may not be representative of the extent of disease. (d) ICA should be diagnosed as (i) normal when ICA PSV is less than 125 cm/sec and no plaque or intimal thickening is visible; (ii) <50% stenosis when ICA PSV is less than 125 cm/sec and plaque or intimal thickening is visible; (iii) 50%–69% stenosis when ICA PSV is 125–230 cm/sec and plaque is visible; (iv) >=70% stenosis to near occlusion when ICA PSV is greater than 230 cm/sec and visible plaque and lumen narrowing are seen; (v) near occlusion when there is a markedly narrowed lumen at color Doppler US; and (vi) total occlusion when there is no detectable patent lumen at gray-scale US and no flow at spectral, power, and color Doppler US. (e) The final report should discuss velocity measurements and gray-scale and color Doppler findings. Study limitations should be noted when they exist. The conclusion should state an estimated degree of ICA stenosis as reflected in the above categories. The panel also considered various technical aspects of carotid US and methods for quality assessment and identified several important unanswered questions meriting future research.

© RSNA, 2003

Index terms: Carotid arteries, flow dynamics • Carotid arteries, stenosis or obstruction, 172.4311, 172.4312, 172.721 • Carotid arteries, US, 172.12981, 172.12983, 172.12984 • Special Reports




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