COLOR-FLOW DOPPLER-ASSISTED DUPLEX IMAGING FAILS TO DETECT ULCERATIONIN HIGH-GRADE INTERNAL CAROTID-ARTERY STENOSIS

Purpose: Pathoanatomic studies suggest that plaque surface disruption, particularly ulceration, plays a key role in the destabilization of i nternal carotid artery stenosis. Until now, the validity of color-flow Doppler-assisted duplex imaging in detecting such pathoanatomically d efined plaque surface abnormalities is unclear. Methods: We prospectiv ely determined the interobserver reliability and validity of detecting plaque ulceration by means of preoperative color-flow Doppler-assiste d duplex imaging in 43 consecutive patients with high-grade (greater t han or equal to 70%) internal carotid artery stenosis, comparing these ultrasonographic findings with pathoanatomic evaluations of the corre sponding endarterectomy specimens. Results: Interobserver reliabilitie s for detecting carotid plaque ulceration were kappa = 0.57 for ultras onography and kappa = 0.82 for the pathologic reference method. Color- flow Doppler-assisted duplex imaging (observer consensus) failed to de tect pathoanatomically defined ulceration chi(2) = 0.43; p = 0.51). Li kewise, sensitivity, specificity, overall accuracy, and positive predi ctive value were poor (33%, 67%, 56%, and 46%, respectively). Conclusi ons: We conclude from our data that color-flow Doppler-assisted duplex imaging is not a reliable or valid means to identify plaque ulceratio n in high-grade carotid artery lesions.