Caveat - Beware my personal bias. May I ask when we are going to finally
recognize that a high quality duplex scan performed by an experienced
sonographer
IS THE GOLD STANDARD?
From: Cuffe R , Rothwell P Stroke 2006;37:1785-1791
At the important 70% stenosis threshold (on conventional angiography) ---
One (1) reader comparing two views had a disagreement rate of 32%
Two (2) readers reading the same best angiographic view had 24%
disagreement.
So if my accuracy is approx. 70% in comparison with angiography, I guess I
am perfect. Come on! US is better than that!
Bill
William B Schroedter, BS, RVT, RPhS, FSVU
Technical Director, Quality Vascular Imaging, Inc
4120 Woodmere Park Blvd
Suite 8B
Venice, Florida 34293
(941) 408-8855 office
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-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Christina
Lewis
Sent: Thursday, October 18, 2012 11:37 AM
To: [log in to unmask]
Subject: Re: CCA criteria
We do not have a criteria for CCA or ECA stenosis, so we cannot call the
percentage range of the stenosis, but we still make sure to point it out -
doubling in velocities from proximal segment, significant turbulence, visual
narrowing on color and/or gray, etc. and then add something like
"suggest/indicate hemodynamically significant stenosis."
I've unfortunately seen a number of patients with a CCA stenosis that were
called ICA stenosis (because of a jet from the CCA increasing the velocities
in the ICA) at other facilities. We also make sure to mention that while
elevated velocities in the ICA indicate an x-y% stenosis, they may be due in
some part to elevated CCA velocities and then mention whether or not we see
some sort of indication that there may also be a separate stenosis within
the ICA.
Not all patients fit perfectly into the criteria boxes, so we do the best we
can to note what we do see - for patient care, of course! :) - while still
keeping an eye on our QA and ICAVL standards. When you find funny stuff
that doesn't fit nicely into your established criteria and you describe its
appearance, rather than quantifying it with criteria you don't use, that
particular study shouldn't count for or against your QA, but still gives
physicians the information they need to treat. The problem arises when we
quantify something we don't have criteria for - yes, that narrowed CCA with
a velocity of 700 cm/s and seriously disturbed flow distally is probably a
>50% stenosis. Call it that and your physicians can treat and then your
>QA
is dinged. But we can still perfectly describe the stenosis without using
the percentage and it's a win-win.
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