Comparison of Visualize:Vascular to Carotid Duplex Exam (CDE) And MRA

Daniel Gurell, MD, Marc Prager, MD 

University Diagnostic Medical Imaging

Purpose: To evaluate the clinical relevance of Visualize:Vascular by comparing results with CDE and MRA for proximal internal carotid artery (pICA) studies. 

Materials and Methods: Blinded prospective study of 50 consecutive carotid duplex exam (CDE) patients age 25-90 years, with medical necessity for CDE testing. The data consists of a total of 96 pICA studies. 46 patients received bilateral CDE while 4 patients received unilateral CDE. Ultrasound images were acquired using a 9 MHz linear probe and stored in DICOM format. Post processed evaluation was performed using Salient Imaging’s Visualize:Vascular. MRA was performed for patients qualifying based upon CDE and/or Visualize:Vascular results.  Blinded radiologists independently diagnosed Stenosis from CDE, Visualize:Vascular, and Magnetic Resonance Angiography (MRA) results. Results were compared and correlation was calculated.

Results: 

Visualize:Vascular to MRA  99% correlation

CDE to MRA                           76% correlation

CDE to Visualize:Vascular   76% correlation

n=96 and p<.05 which means that the results are statistically significant. Visualize:Vascular differed from MRA on one study (severe vs. critical) without effect on patient management. The same study was rated “moderate” using CDE. CDE correlated with MRA results 76%, Visualize:Vascular and MRA both outperform CDE. Visualize:Vascular correlated with MRA on 99% of the studies.

Conclusion: Stroke is the leading cause of morbidity and the third leading cause of death. CDE is the first line diagnostic test used to determine carotid disease. Yet there are conditions when CDE is inhibited by artifacts, impacting results. Sensitivity and specificity of CDE results are statistically improved when used in conjunction with Visualize:Vascular, and may obviate the need for unnecessary additional testing while moving diseased patients to definitive therapy more rapidly.

Clinical Relevance Statement: CDE is presently used as a first line diagnostic test in evaluating suspected carotid artery disease. CDE results can vary, based on morphology, calcified plaque and technique. Visualize:Vascular significantly improves diagnostic capability of CDE with results matching those of MRA.