Table of Contents
Advances in Vascular Medicine
Volume 2015, Article ID 905384, 6 pages
http://dx.doi.org/10.1155/2015/905384
Review Article

A Critical Evaluation of Carotid Duplex Scanning in the Diagnosis of Significant Carotid Artery Occlusive Disease

1Department of Surgery, The Ohio State University Wexner Medical Center, 376 West 10th Avenue, Prior Hall 7th Floor, Columbus, OH 43210, USA
2Vascular Laboratory, The Ohio State University Wexner Medical Center, 376 West 10th Avenue, Prior Hall 7th Floor, Columbus, OH 43210, USA
3Division of Vascular Disease and Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, 376 West 10th Avenue, Prior Hall 7th Floor, Columbus, OH 43210, USA

Received 1 July 2014; Revised 2 February 2015; Accepted 3 February 2015

Academic Editor: Roberto Pola

Copyright © 2015 Jon C. Henry et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Carotid duplex (CD) scanning is the primary method of evaluating patients suspected of having extracranial carotid occlusive disease. It is incumbent on vascular laboratories (VL) to have internally validated criteria confirming overall accuracy, specificity (SP), sensitivity (SS), negative predictive value (NPV), and positive predictive value (PPV). Receiver operating characteristic (ROC) curves allow further analysis to update existing criteria. We correlated 127 internal carotid arteries studied by carotid duplex scanning and confirmatory modalities, which showed a SP of 83.3%, SS of 97.9%, NPV of 92.5%, PPV of 95%, and overall accuracy of 94.5% for >50% internal carotid artery stenosis. For >70% stenosis, SP was 88.8%, SS was 96.1%, NPV was 93.6%, PPV was 92.5%, and overall accuracy was 92.9%. ROC curves for the peak systolic velocities were used; for detecting a 50–69% stenosis range a sensitivity of 88%, specificity of 93%, NPV of 73%, and PPV of 97% were found. For detecting a 70–99% stenosis a sensitivity of 95%, specificity of 90%, NPV of 93%, and a PPV of 93% were found. All vascular laboratories must have a vigorous quality assurance program and must validate their own internal criteria or the recently promulgated consensus criteria for grading the severity of carotid stenosis by carotid duplex examination.