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Date Published: 09/07/2024
Online Published: 31/03/2024
Abstract Views: 55
Views pdf: 72
DOI: https://doi.org/10.55046/vjrnm.54.1024.2024
Issue
No. 54 (2024)
Section
Scientific research
How to Cite
Do, N. C., Nguyen, V. D., Nguyen, T. X. M., Nguyen, H. T., Doan, D. T., Nguyen, H. A., Pham, Q. T. T., & Nguyen, T. N. N. (2024). VALUE OF DUPLEX ULTRASOUND IN THE DIAGNOSIS OF EXTRACRANIAL INTERNAL CAROTID STENOSIS IN PATIENTS WITH CEREBRAL INFARCTION. Vietnamese Journal of Radiology and Nuclear Medicine, 54, 60-70. https://doi.org/10.55046/vjrnm.54.1024.2024

VALUE OF DUPLEX ULTRASOUND IN THE DIAGNOSIS OF EXTRACRANIAL INTERNAL CAROTID STENOSIS IN PATIENTS WITH CEREBRAL INFARCTION

Do Ngoc Cuong1,, Nguyen Vu Dang1, Nguyen Thi Xuan Mai1, Nguyen Hoang Thuan1, Doan Dung Tien1, Nguyen Hoang An1, Pham Quach Tran Tran1, Nguyen Tran Nhu Ngoc
1 Can Tho University of Medicine and Pharmacy

Main Article Content

Abstract

Background: Extracranial internal carotid artery stenosis is the cause of approximately 8 - 15% of cerebral infarction cases. The accurate diagnosis of this pathology aids clinicians in making a prognosis and selecting appropriate treatment methods. Duplex ultrasound is a diagnostic imaging method that is both non-invasive and inexpensive, helping to diagnose extracranial internal carotid artery stenosis.


Objectives: The objective of our study is to describe the clinical, duplex ultrasound characteristics and evaluate the value of duplex ultrasound for the diagnosis of extracranial internal carotid stenosis in patients with cerebral infarction.


Materials and methods: A prospective cross-sectional study involving 64 brain infarction patients (128 internal carotid arteries on both sides) at Can Tho Central Hospital from 03/2021 to 06/2023.


Results: The most common clinical symptoms of cerebral infarction were weak or hemiplegia (95.3%) and central facial palsy (62.5%). The extracranial internal carotid artery was stenosis or occlusion in 62.5% of patients with cerebral infarction. Duplex ultrasound was highly effective in detecting extracranial internal carotid stenosis. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value for detecting ≥ 50% extracranial internal carotid atery stenosis were 96.6%, 99.0%, 98.4%, 96.6%, 99.0%, and there was almost perfect agreement with the DSA results (k = 0.955, 95% CI = 0.894 - 1, p < 0.001). The values were 92.3%, 99.1%, 98.4%, 92.3%, 99.1%, and the agreement was almost perfect compared to DSA (k = 0.914, 95% CI = 0.796 - 1, p < 0.001) in a stenosis of ≥ 70% extracranial internal carotid atery. Duplex ultrasound and DSA have a high correlation in the diagnosis of extracranial internal carotid atery stenosis (Spearman’s rs = 0.728, 95% CI: 0.632 - 0.803, p < 0.001).


Conclusion: Duplex ultrasound is a non-invasive, inexpensive, safe, and highly accurate imaging tool for the diagnosis of extracranial internal carotid stenosis. It can be utilized for initial screening to classify the degree of stenosis and/or for a definitive diagnosis.

Article Details

Keywords

duplex ultrasound, digital suppression angiography, cerebral infarction, internal carotid artery stenosis

References

1. Mai Duy Tôn. Kết quả ban đầu nghiên cứu đột quỵ đa trung tâm tại Việt Nam. Hội nghị đột quỵ quốc tế 2022: “Thách thức và cơ hội”, Hà Nội, 05/11/2022.
2. Krawisz A. K., Carroll B. J. and Secemsky E. A. Risk-Stratification and Management of Extracranial Carotid Artery Disease. Cardiology clinics. 2021; 39(4): 539-549.
3. Gaitini D. and Soudack M. Diagnosing carotid stenosis by Doppler sonography: state of the art. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. 2005; 24(8): 1127-1136.
4. Haverich A. and Boyle E.C., Haverich A. và Boyle E. C. dịch. Atherosclerosis Risk Factors. Springer. 2019. 9-45.
5. Ismail A., Ravipati S., Gonzalez-Hernandez D., Mahmood H., Imran A., Munoz E.J., et al. Carotid Artery Stenosis: A Look Into the Diagnostic and Management Strategies, and Related Complications. Cureus. 2023; 15(5): 1-16.
6. Intersocietal Accreditation Commission (IAC). IAC Vascular Testing White Paper on Carotid Stenosis Interpretation Criteria. 2014: 1-2.
7. Grant E. G., Benson C. B., Moneta G. L., Alexandrov A. V., Baker J. D., Bluth E. I., et al. Carotid Artery Stenosis: Gray-Scale and Doppler US Diagnosis - Society of Radiologists in Ultrasound Consensus Conference. Radiology. 2003; 229(2): 340-346.
8. Barnett H.J.M., Taylor D.W., Haynes R.B., Sackett D.L., Peerless S.J., G G Ferguson G.G., et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. The New England journal of medicine. 1991; 325(7): 445-453.
9. Harris M. and Taylor G. Medical Statistics Made Easy. 4th Edition. United Kingdom: Scion; 2021: 49-53.
10. Peacock J.L. and Peacock P.J. Oxford Handbook of Medical Statistics. Second edition. United Kingdom: Oxford University Press; 2020: 405-438.
11. Nguyễn Hoàng Ngọc. Nghiên cứu thực trạng hẹp động mạch cảnh ở bệnh nhân nhồi máu não và hẹp động mạch cảnh không triệu chứng bằng siêu âm doppler. Luận văn Tiến sĩ Y học, Học viện Quân Y; 2002.
12. Phùng Đức Lâm. Nghiên cứu đặc điểm lâm sàng, hình ảnh tổn thương hệ động mạch cảnh trong ở bệnh nhân đột quỵ nhồi máu não. Luận văn Tiến sĩ Y học, Học viện Quân Y; 2017.
13. Brott T.G., Hobson R.W., Howard G., Roubin G.S., Clark W.M., Brooks W., et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. New England Journal of Medicine. 2010; 363(1): 11-23.
14. Trần Nguyễn Phương Hải. Nghiên cứu đặc điểm lâm sàng, cận lâm sàng và kết quả điều trị hẹp động mạch cảnh đoạn ngoài sọ bằng phương pháp can thiệp qua da. Luận văn Tiến sĩ Y học, Viện Nghiên cứu khoa học Y Dược lâm sàng 108; 2018.
15. Đỗ Quang Huân. Cao huyết áp và bệnh xơ vữa động mạch. Thành phố Hồ Chí Minh: Nhà xuất bản Y học; 2010: 43-48.
16. Wei L.M., Zhu Y.Q., Bao Y.Q., Lu H.T., Zhang P.L., Zhao Y.W., et al. Atherosclerosis in intracranial or extracranial vessels in diabetic patients and the association with stroke subtype. Quantitative Imaging in Medicine and Surgery. 2019; 9(6): 960-967.
17. Holt R.I.G., Cockram C.S., Flyvbjerg A. and Goldstein B.J. Textbook of Diabetes. Fifth edition. United Kingdom: Wiley-Blackwell; 2016: Pathogenesis of Macrovascular Complications in Diabetes, 611-628.
18. Kiriyama H., Kaneko H., Itoh H., Yoshida Y., Nakanishi K., Mizuno Y., et al. Effect of cigarette smoking on carotid artery atherosclerosis: a community-based cohort study. Heart and Vessels. 2019; 35(1): 22-29.
19. Hahad O., Kuntic M., Kuntic I., Daiber A. and Münzel T. Tobacco smoking and vascular biology and function: evidence from human studies. Pflugers Archiv : European journal of physiology. 2023; 475(7): 797-805.
20. McColgan P., Bentley P., McCarron M. and Sharma P. Evaluation of the clinical utility of a carotid bruit. QJM: An International Journal of Medicine. 2012; 105(12): 1171-1177.
21. AbuRahma A. F., Avgerinos E. D., Chang R. W., Darling R. C., Duncan A. A., Forbes T. L., et al. The Society for Vascular Surgery implementation document for management of extracranial cerebrovascular disease. Journal of Vascular Surgery. 2022; 75(1): 26S-98S.
22. Henry J. C., Kiser D. and Satiani B. A Critical Evaluation of Carotid Duplex Scanning in the Diagnosis of Significant Carotid Artery Occlusive Disease. Advances in Vascular Medicine. 2015: 1-6.
23. Cui H., Yan R., Zhai Z., Ren J., Li Z., Li Q. and Wang S. Comparative analysis of 3D time-resolved contrastenhanced magnetic resonance angiography, color Doppler ultrasound and digital subtraction angiography in symptomatic carotid stenosis. Experimental and Therapeutic Medicine. 2018; 15(2): 1654-1659.