Volume : 09, Issue : 03, March – 2021
37.COMPARISON OF CAROTID DOPPLER ULTRASOUND AND COMPUTERIZED TOMOGRAPHIC ANGIOGRAPHY IN THE EVALUATION OF CAROTID ARTERY STENOSIS: A SYSTEMIC REVIEW AND META-ANALYSIS
Maisa ali altarouti, Marwa ali altarouti, Sara ali altarouti
Abstract :
Introduction: Accurate non-invasive carotid imaging is important for effective secondary stroke prevention. We conducted a systematic review and meta-analysis to compare DUS and CTA accuracy for diagnosing (70-99%) carotid artery stenosis. Methodology: A systematic search was conducted in PubMed and Embase from February, 2021, to March, 2021, to compare diagnostic test accuracy of DUS and CTA. The stated method for determining the degree of stenosis (e.g., NASCET or ECST) Results: In 23 included studies with 3229 participants, the pooled sensitivity for CTA test is 0.79 [0.72, 0.85], and the pooled specificity is 0.93 [0.84, 0.97]. We also found that the pooled sensitivity for DUS test is 0.90 [0.80, 0.95], and the pooled specificity is 0.87 [0.75, 0.94]. Regarding the CTA test, most of the points gathered around the top left of the graph, with the area under the curve of 0.87 [0.84-0.90], indicate the test’s good accuracy. For the DUS test, most of the points clustered around the top left of the graph, with area under the curve of 0.95 [0.92-0.95], indicating high accuracy of the test. Conclusion: We found relatively high sensitivity and specificity of both CTA and DUS tests. However, the DUS test’s accuracy in diagnosing (70-99%) carotid artery stenosis was greater than CTA.
Cite This Article:
Please cite this article in press Maisa ali altarouti et al., Comparison Of Carotid Doppler Ultrasound And Computerized Tomographic Angiography In The Evaluation Of Carotid Artery Stenosis: A Systemic Review And Meta-Analysis., Indo Am. J. P. Sci, 2021; 08(03).
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References:
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8. Franceschi C. L’investigation vasculaire par ultrasonographie Doppler. Masson; 1977.
9. DuBose TJ, Baker AL. Acoustic Doppler shifts in medicine. Applied acoustics. 2007 Mar 1;68(3):240-4.
10. DuBose TJ, Baker AL. Confusion and direction in diagnostic Doppler sonography. Journal of Diagnostic Medical Sonography. 2009 May;25(3):173-7.
11. Steinke W, Kloetzsch C, Hennerici M. Carotid artery disease assessed by color Doppler flow imaging: correlation with standard Doppler sonography and angiography. AJR. American journal of roentgenology. 1990 May;154(5):1061-8.
12. Middleton WD, Foley WD, Lawson TL. Color-flow Doppler imaging of carotid artery abnormalities. American Journal of Roentgenology. 1988 Feb 1;150(2):419-25.
13. Dillon EH, Van Leeuwen MS, Fernandez MA, Eikelboom BC, Mali WP. CT angiography: application to the evaluation of carotid artery stenosis. Radiology. 1993 Oct;189(1):211-9.
14. Heinz ER, Pizer SM, Fuchs H, Fram EK, Burger P, Drayer BP, Osborne DR. Examination of the extra-cranial carotid bifurcation by thin-section dynamic CT: direct visualization of intimal atheroma in man (Part 1). American journal of neuroradiology. 1984 Jul 1;5(4):355-9.
15. Chen CJ, Lee TH, Hsu HL, Tseng YC, Lin SK, Wang LJ, Wong YC. Multi-slice CT angiography in diagnosing total versus near occlusions of the internal carotid artery: comparison with catheter angiography. Stroke. 2004 Jan 1;35(1):83-5.
16. Porsche C, Walker L, Mendelow D, Birchall D. Evaluation of cross-sectional luminal morphology in carotid atherosclerotic disease by use of spiral CT angiography. Stroke. 2001 Nov 1;32(11):2511-5.
17. Whiting, Penny F, Anne W. S Rutjes, Marie E Westwood, Susan Mallett, Jonathan J Deeks, Johannes B Reitsma, Mariska M. G Leeflang, Jonathan A. C Sterne, and Patrick M. M Bossuyt. “QUADAS-2: a Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies.” Annals of internal medicine 155, no. 8 (2011): 529–536.
18. Bossuyt PM Reitsma JB Bruns DE et al. Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative.
19. Clin Radiol. 2003; 58: 575-580Haynes RB, Wilczynski NL. Optimal search strategies for retrieving scientifically strong studies of diagnosis from Medline: analytical survey. Bmj. 2004 Apr 29;328(7447):1040.
20. Fleiss JL, Levin B, Paik MC. The comparison of proportions from several independent samples. Statistical methods for rates and proportions. 1981;9:138-59.
21. Vanninen R, Manninen H, Soimakallio S. Imaging of carotid artery stenosis: clinical efficacy and cost-effectiveness. American journal of neuroradiology. 1995 Oct 1;16(9):1875-83.
22. Sitzer M, Fürst G, Fischer H, Siebler M, Fehlings T, Kleinschmidt A, Kahn T, Steinmetz H. Between-method correlation in quantifying internal carotid stenosis. Stroke. 1993 Oct;24(10):1513-8.
23. Patel MR, Kuntz KM, Klufas RA, Kim D, Kramer J, Polak JF, Skillman JJ, Whittemore AD, Edelman RR, Kent KC. Preoperative assessment of the carotid bifurcation: can magnetic resonance angiography and duplex ultrasonography replace contrast arteriography?. Stroke. 1995 Oct;26(10):1753-8.
24. Nederkoorn PJ, Mali WP, Eikelboom BC, Elgersma OE, Buskens E, Hunink MM, Kappelle LJ, Buijs PC, Wüst AF, van der Lugt A, van der Graaf Y. Preoperative diagnosis of carotid artery stenosis: accuracy of noninvasive testing. Stroke. 2002 Aug 1;33(8):2003-8.
25. Link J, Brossmann J, Penselin V, Glüer CC, Heller M. Common carotid artery bifurcation: preliminary results of CT angiography and color-coded duplex sonography compared with digital subtraction angiography. AJR. American journal of roentgenology. 1997 Feb;168(2):361-5.
26. Knudsen L, Johansen A, Justesen P, Jùrgensen HB. Accuracy of duplex scan of internal carotid arteries. parameters. 2002 Jul 1;3:4.
27. de la Cruz Cosme C, Milner MD, Burgos GO, Tur AG, Martínez MM, Segura T. Validation of a basic neurosonology laboratory for detecting cervical carotid artery stenosis. Neurología (English Edition). 2019 Jul 1;34(6):367-75.
28. Chappell FM, Wardlaw JM, Young GR, Gillard JH, Roditi GH, Yip B, Pell JP, Rothwell PM, Brown MM, Gough MJ, Randall MS. Carotid artery stenosis: accuracy of non-invasive tests—individual patient data meta-analysis. Radiology. 2009 May;251(2):493-502.
29. Borisch I, Horn M, Butz B, Zorger N, Draganski B, Hoelscher T, Bogdahn U, Link J. Preoperative evaluation of carotid artery stenosis: comparison of contrast-enhanced MR angiography and duplex sonography with digital subtraction angiography. American journal of neuroradiology. 2003 Jun 1;24(6):1117-22.
30. Bönig L, Weder B, Schött D, Keel A, Nguyen T, Zaunbauer W. Prediction of angiographic carotid artery stenosis indexes by colour Doppler‐assisted duplex imaging. A critical appraisal of the parameters used. European journal of neurology. 2000 Mar;7(2):183-90.
31. Simeone A, Carriero A, Armillotta M, Scarabino T, Nardella M, Ceddia A, Magarelli N, Salvolini U, Bonomo L. Spiral CT angiography in the study of the carotid stenoses. Journal of Neuroradiology= Journal de Neuroradiologie. 1997 Jun 1;24(1):18-22.
32. Santos AL, Ramos M, Delgado F, Cano A, Bravo F. Computed tomography angiography in the evaluation of carotid artery bifurcation stenosis: comparison with intraarterial digital subtraction angiography; Angio-TC en la evaluacion de estenosis de la bifurcacion arterial carotidea: comparacion con arteriografia por sustraccion digital intraarterial. Radiologia (Madrid). 2001 Jul 1;43.
33. Randoux B, Marro B, Koskas F, Duyme M, Sahel M, Zouaoui A, Marsault C. Carotid artery stenosis: prospective comparison of CT, three-dimensional gadolinium-enhanced MR, and conventional angiography. Radiology. 2001 Jul;220(1):179-85.
34. Magarelli N, Scarabino T, Simeone AL, Florio F, Carriero A, Salvolini U, Bonomo L. Carotid stenosis: a comparison between MR and spiral CT angiography. Neuroradiology. 1998 Jun;40(6):367-73.
35. Link J, Brossmann J, Grabener M, Mueller-Huelsbeck S, Steffens JC, Brinkmann G, Heller M. Spiral CT angiography and selective digital subtraction angiography of internal carotid artery stenosis. American journal of neuroradiology. 1996 Jan 1;17(1):89-94.
36. Leclerc X, Godefroy O, Lucas C, Benhaim JF, Michel TS, Leys D, Pruvo JP. Internal carotid arterial stenosis: CT angiography with volume rendering. Radiology. 1999 Mar;210(3):673-82.
37. Hirai T, Korogi Y, Ono K, Murata Y, Takahashi M, Suginohara K, Uemura S. Maximum stenosis of extra-cranial internal carotid artery: effect of luminal morphology on stenosis measurement by using CT angiography and conventional DSA. Radiology. 2001 Dec;221(3):802-9.
38. Dillon EH, Van Leeuwen MS, Fernandez MA, Eikelboom BC, Mali WP. CT angiography: application to the evaluation of carotid artery stenosis. Radiology. 1993 Oct;189(1):211-9.
39. Cumming MJ, Morrow IM. Carotid artery stenosis: a prospective comparison of CT angiography and conventional angiography. AJR. American journal of roentgenology. 1994 Sep;163(3):517-23.
40. Castillo M, Wilson JD. CT angiography of the common carotid artery bifurcation: comparison between two techniques and conventional angiography. Neuroradiology. 1994 Nov 1;36(8):602-4. Bozzao 2001
41. Bozzao A, Floris R, Villani A, Varrucciu V, Baviera ME, Simonetti G. An evaluation of the carotid bifurcation and of the intracranial circle by angio-spiral computed tomography. La Radiologia Medica. 1998 Jun 1;95(6):577-82.
42. Anderson GB, Ashforth R, Steinke DE, Ferdinandy R, Findlay JM. CT angiography for the detection and characterization of carotid artery bifurcation disease. Stroke. 2000 Sep;31(9):2168-74.
43. Alvarez-Linera J, Benito-León J, Escribano J, Campollo J, Gesto R. Prospective evaluation of carotid artery stenosis: elliptic centric contrast-enhanced MR angiography and spiral CT angiography compared with digital subtraction angiography. American journal of neuroradiology. 2003 May 1;24(5):1012-9.
44. Bartlett ES, Walters TD, Symons SP, Fox AJ. Diagnosing carotid stenosis near-occlusion by using CT angiography. American Journal of Neuroradiology. 2006 Mar 1;27(3):632-7.
45. Wardlaw JM, Chappell FM, Best JJ, Wartolowska K, Berry E. Non-invasive imaging compared with intra-arterial angiography in the diagnosis of symptomatic carotid stenosis: a meta-analysis. The Lancet. 2006 May 6;367(9521):1503-12.
46. Hollingworth W, Nathens AB, Kanne JP, Crandall ML, Crummy TA, Hallam DK, Wang MC, Jarvik JG. The diagnostic accuracy of computed tomography angiography for traumatic or atherosclerotic lesions of the carotid and vertebral arteries: a systematic review. Eur J Radiol. 2003; 48: 88–102.
47. Kwon BJ, Jung C, Sheen SH, Cho JH, Han MH. CT angiography of stented carotid arteries: comparison with Doppler ultrasonography. Journal of Endovascular Therapy. 2007 Aug;14(4):489-97.
48. Schaller B. Extracranial-intracranial bypass to reduce the risk of ischemic stroke in intracranial aneurysms of the anterior cerebral circulation: a systematic review. Journal of Stroke and Cerebrovascular Diseases. 2008 Sep 1;17(5):287-98.
49. Layton KF, Huston 3rd J, Cloft HJ, Kaufmann TJ, Krecke KN, Kallmes DF. Specificity of MR angiography as a confirmatory test for carotid artery stenosis: is it valid?. American Journal of Roentgenology. 2007 Apr;188(4):1114-6.
50. Sameshima T, Futami S, Morita Y, Yokogami K, Miyahara S, Sameshima Y, Goya T, Wakisaka S. Clinical usefulness of and problems with three-dimensional CT angiography for the evaluation of arteriosclerotic stenosis of the carotid artery: comparison with conventional angiography, MRA, and ultrasound sonography. Surgical neurology. 1999 Mar 1;51(3):300-9.
51. Grant EG, Duerinckx AJ, El Saden SM, Melany ML, Hathout GM, Zimmerman PT, Marumoto AK, Cohen SN, Baker JD. Ability to use duplex US to quantify internal carotid arterial stenoses: fact or fiction?. Radiology. 2000 Jan;214(1):247-52.
52. Zwiebel WJ, Austin CW, Sackett JF, Strother CM. Correlation of high-resolution, B-mode and continuous-wave Doppler sonography with arteriography in the diagnosis of carotid stenosis. Radiology. 1983 Nov;149(2):523-32.
2. Wessels T, Harrer JU, Stetter S, Mull M, Klötzsch C. Three-dimensional assessment of extra-cranial Doppler sonography in carotid artery stenosis compared with digital subtraction angiography. Stroke. 2004 Aug 1;35(8):1847-51.
3. Estol CJ. Dr C. Miller Fisher and the history of carotid artery disease. Stroke. 1996 Mar;27(3):559-66.
4. Dyken ML. Carotid endarterectomy studies: a glimmering of science. Stroke. 1986 May;17(3):355-8.
5. Beaglehole R, Yach D. Globalisation and the prevention and control of non-communicable disease: the neglected chronic diseases of adults. The Lancet. 2003 Sep 13;362(9387):903-8.
6. WHO. Global status report on noncommunicable diseases 2010: description of the global burden of NCDs, their risk factors and determinants. WHO. 2011 Apr.
7. WHO. About cardiovascular diseases. Geneva: World Health Organization. Online. Available at: https://www.who.int/cardiovascular_diseases/about_cvd/en/ [Accessed 20th March 2021].
8. Franceschi C. L’investigation vasculaire par ultrasonographie Doppler. Masson; 1977.
9. DuBose TJ, Baker AL. Acoustic Doppler shifts in medicine. Applied acoustics. 2007 Mar 1;68(3):240-4.
10. DuBose TJ, Baker AL. Confusion and direction in diagnostic Doppler sonography. Journal of Diagnostic Medical Sonography. 2009 May;25(3):173-7.
11. Steinke W, Kloetzsch C, Hennerici M. Carotid artery disease assessed by color Doppler flow imaging: correlation with standard Doppler sonography and angiography. AJR. American journal of roentgenology. 1990 May;154(5):1061-8.
12. Middleton WD, Foley WD, Lawson TL. Color-flow Doppler imaging of carotid artery abnormalities. American Journal of Roentgenology. 1988 Feb 1;150(2):419-25.
13. Dillon EH, Van Leeuwen MS, Fernandez MA, Eikelboom BC, Mali WP. CT angiography: application to the evaluation of carotid artery stenosis. Radiology. 1993 Oct;189(1):211-9.
14. Heinz ER, Pizer SM, Fuchs H, Fram EK, Burger P, Drayer BP, Osborne DR. Examination of the extra-cranial carotid bifurcation by thin-section dynamic CT: direct visualization of intimal atheroma in man (Part 1). American journal of neuroradiology. 1984 Jul 1;5(4):355-9.
15. Chen CJ, Lee TH, Hsu HL, Tseng YC, Lin SK, Wang LJ, Wong YC. Multi-slice CT angiography in diagnosing total versus near occlusions of the internal carotid artery: comparison with catheter angiography. Stroke. 2004 Jan 1;35(1):83-5.
16. Porsche C, Walker L, Mendelow D, Birchall D. Evaluation of cross-sectional luminal morphology in carotid atherosclerotic disease by use of spiral CT angiography. Stroke. 2001 Nov 1;32(11):2511-5.
17. Whiting, Penny F, Anne W. S Rutjes, Marie E Westwood, Susan Mallett, Jonathan J Deeks, Johannes B Reitsma, Mariska M. G Leeflang, Jonathan A. C Sterne, and Patrick M. M Bossuyt. “QUADAS-2: a Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies.” Annals of internal medicine 155, no. 8 (2011): 529–536.
18. Bossuyt PM Reitsma JB Bruns DE et al. Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative.
19. Clin Radiol. 2003; 58: 575-580Haynes RB, Wilczynski NL. Optimal search strategies for retrieving scientifically strong studies of diagnosis from Medline: analytical survey. Bmj. 2004 Apr 29;328(7447):1040.
20. Fleiss JL, Levin B, Paik MC. The comparison of proportions from several independent samples. Statistical methods for rates and proportions. 1981;9:138-59.
21. Vanninen R, Manninen H, Soimakallio S. Imaging of carotid artery stenosis: clinical efficacy and cost-effectiveness. American journal of neuroradiology. 1995 Oct 1;16(9):1875-83.
22. Sitzer M, Fürst G, Fischer H, Siebler M, Fehlings T, Kleinschmidt A, Kahn T, Steinmetz H. Between-method correlation in quantifying internal carotid stenosis. Stroke. 1993 Oct;24(10):1513-8.
23. Patel MR, Kuntz KM, Klufas RA, Kim D, Kramer J, Polak JF, Skillman JJ, Whittemore AD, Edelman RR, Kent KC. Preoperative assessment of the carotid bifurcation: can magnetic resonance angiography and duplex ultrasonography replace contrast arteriography?. Stroke. 1995 Oct;26(10):1753-8.
24. Nederkoorn PJ, Mali WP, Eikelboom BC, Elgersma OE, Buskens E, Hunink MM, Kappelle LJ, Buijs PC, Wüst AF, van der Lugt A, van der Graaf Y. Preoperative diagnosis of carotid artery stenosis: accuracy of noninvasive testing. Stroke. 2002 Aug 1;33(8):2003-8.
25. Link J, Brossmann J, Penselin V, Glüer CC, Heller M. Common carotid artery bifurcation: preliminary results of CT angiography and color-coded duplex sonography compared with digital subtraction angiography. AJR. American journal of roentgenology. 1997 Feb;168(2):361-5.
26. Knudsen L, Johansen A, Justesen P, Jùrgensen HB. Accuracy of duplex scan of internal carotid arteries. parameters. 2002 Jul 1;3:4.
27. de la Cruz Cosme C, Milner MD, Burgos GO, Tur AG, Martínez MM, Segura T. Validation of a basic neurosonology laboratory for detecting cervical carotid artery stenosis. Neurología (English Edition). 2019 Jul 1;34(6):367-75.
28. Chappell FM, Wardlaw JM, Young GR, Gillard JH, Roditi GH, Yip B, Pell JP, Rothwell PM, Brown MM, Gough MJ, Randall MS. Carotid artery stenosis: accuracy of non-invasive tests—individual patient data meta-analysis. Radiology. 2009 May;251(2):493-502.
29. Borisch I, Horn M, Butz B, Zorger N, Draganski B, Hoelscher T, Bogdahn U, Link J. Preoperative evaluation of carotid artery stenosis: comparison of contrast-enhanced MR angiography and duplex sonography with digital subtraction angiography. American journal of neuroradiology. 2003 Jun 1;24(6):1117-22.
30. Bönig L, Weder B, Schött D, Keel A, Nguyen T, Zaunbauer W. Prediction of angiographic carotid artery stenosis indexes by colour Doppler‐assisted duplex imaging. A critical appraisal of the parameters used. European journal of neurology. 2000 Mar;7(2):183-90.
31. Simeone A, Carriero A, Armillotta M, Scarabino T, Nardella M, Ceddia A, Magarelli N, Salvolini U, Bonomo L. Spiral CT angiography in the study of the carotid stenoses. Journal of Neuroradiology= Journal de Neuroradiologie. 1997 Jun 1;24(1):18-22.
32. Santos AL, Ramos M, Delgado F, Cano A, Bravo F. Computed tomography angiography in the evaluation of carotid artery bifurcation stenosis: comparison with intraarterial digital subtraction angiography; Angio-TC en la evaluacion de estenosis de la bifurcacion arterial carotidea: comparacion con arteriografia por sustraccion digital intraarterial. Radiologia (Madrid). 2001 Jul 1;43.
33. Randoux B, Marro B, Koskas F, Duyme M, Sahel M, Zouaoui A, Marsault C. Carotid artery stenosis: prospective comparison of CT, three-dimensional gadolinium-enhanced MR, and conventional angiography. Radiology. 2001 Jul;220(1):179-85.
34. Magarelli N, Scarabino T, Simeone AL, Florio F, Carriero A, Salvolini U, Bonomo L. Carotid stenosis: a comparison between MR and spiral CT angiography. Neuroradiology. 1998 Jun;40(6):367-73.
35. Link J, Brossmann J, Grabener M, Mueller-Huelsbeck S, Steffens JC, Brinkmann G, Heller M. Spiral CT angiography and selective digital subtraction angiography of internal carotid artery stenosis. American journal of neuroradiology. 1996 Jan 1;17(1):89-94.
36. Leclerc X, Godefroy O, Lucas C, Benhaim JF, Michel TS, Leys D, Pruvo JP. Internal carotid arterial stenosis: CT angiography with volume rendering. Radiology. 1999 Mar;210(3):673-82.
37. Hirai T, Korogi Y, Ono K, Murata Y, Takahashi M, Suginohara K, Uemura S. Maximum stenosis of extra-cranial internal carotid artery: effect of luminal morphology on stenosis measurement by using CT angiography and conventional DSA. Radiology. 2001 Dec;221(3):802-9.
38. Dillon EH, Van Leeuwen MS, Fernandez MA, Eikelboom BC, Mali WP. CT angiography: application to the evaluation of carotid artery stenosis. Radiology. 1993 Oct;189(1):211-9.
39. Cumming MJ, Morrow IM. Carotid artery stenosis: a prospective comparison of CT angiography and conventional angiography. AJR. American journal of roentgenology. 1994 Sep;163(3):517-23.
40. Castillo M, Wilson JD. CT angiography of the common carotid artery bifurcation: comparison between two techniques and conventional angiography. Neuroradiology. 1994 Nov 1;36(8):602-4. Bozzao 2001
41. Bozzao A, Floris R, Villani A, Varrucciu V, Baviera ME, Simonetti G. An evaluation of the carotid bifurcation and of the intracranial circle by angio-spiral computed tomography. La Radiologia Medica. 1998 Jun 1;95(6):577-82.
42. Anderson GB, Ashforth R, Steinke DE, Ferdinandy R, Findlay JM. CT angiography for the detection and characterization of carotid artery bifurcation disease. Stroke. 2000 Sep;31(9):2168-74.
43. Alvarez-Linera J, Benito-León J, Escribano J, Campollo J, Gesto R. Prospective evaluation of carotid artery stenosis: elliptic centric contrast-enhanced MR angiography and spiral CT angiography compared with digital subtraction angiography. American journal of neuroradiology. 2003 May 1;24(5):1012-9.
44. Bartlett ES, Walters TD, Symons SP, Fox AJ. Diagnosing carotid stenosis near-occlusion by using CT angiography. American Journal of Neuroradiology. 2006 Mar 1;27(3):632-7.
45. Wardlaw JM, Chappell FM, Best JJ, Wartolowska K, Berry E. Non-invasive imaging compared with intra-arterial angiography in the diagnosis of symptomatic carotid stenosis: a meta-analysis. The Lancet. 2006 May 6;367(9521):1503-12.
46. Hollingworth W, Nathens AB, Kanne JP, Crandall ML, Crummy TA, Hallam DK, Wang MC, Jarvik JG. The diagnostic accuracy of computed tomography angiography for traumatic or atherosclerotic lesions of the carotid and vertebral arteries: a systematic review. Eur J Radiol. 2003; 48: 88–102.
47. Kwon BJ, Jung C, Sheen SH, Cho JH, Han MH. CT angiography of stented carotid arteries: comparison with Doppler ultrasonography. Journal of Endovascular Therapy. 2007 Aug;14(4):489-97.
48. Schaller B. Extracranial-intracranial bypass to reduce the risk of ischemic stroke in intracranial aneurysms of the anterior cerebral circulation: a systematic review. Journal of Stroke and Cerebrovascular Diseases. 2008 Sep 1;17(5):287-98.
49. Layton KF, Huston 3rd J, Cloft HJ, Kaufmann TJ, Krecke KN, Kallmes DF. Specificity of MR angiography as a confirmatory test for carotid artery stenosis: is it valid?. American Journal of Roentgenology. 2007 Apr;188(4):1114-6.
50. Sameshima T, Futami S, Morita Y, Yokogami K, Miyahara S, Sameshima Y, Goya T, Wakisaka S. Clinical usefulness of and problems with three-dimensional CT angiography for the evaluation of arteriosclerotic stenosis of the carotid artery: comparison with conventional angiography, MRA, and ultrasound sonography. Surgical neurology. 1999 Mar 1;51(3):300-9.
51. Grant EG, Duerinckx AJ, El Saden SM, Melany ML, Hathout GM, Zimmerman PT, Marumoto AK, Cohen SN, Baker JD. Ability to use duplex US to quantify internal carotid arterial stenoses: fact or fiction?. Radiology. 2000 Jan;214(1):247-52.
52. Zwiebel WJ, Austin CW, Sackett JF, Strother CM. Correlation of high-resolution, B-mode and continuous-wave Doppler sonography with arteriography in the diagnosis of carotid stenosis. Radiology. 1983 Nov;149(2):523-32.