Diagnostic Accuracy of Carotid Doppler Ultrasonography in Detecting Carotid Artery Stenosis Keeping CT Angiography as Gold Standard in Patients with Cerebral Ischemic Events
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Abstract
Background: Carotid artery stenosis is an important contributor to cerebral ischemic events, and accurate vascular imaging is required for appropriate clinical assessment. Carotid Doppler ultrasonography (CDUS) offers a noninvasive and accessible alternative to CT angiography (CTA). Objective: To determine the diagnostic accuracy of CDUS for detecting carotid artery stenosis in patients with cerebral ischemic events, using CTA as the reference standard. Methods: This cross-sectional diagnostic-accuracy study included 120 patients aged 18–75 years presenting to the Department of Radiology, KRL Hospital, Islamabad, from 1 January to 5 April 2025. All participants underwent CDUS and CTA. Diagnostic performance was evaluated using a 2 × 2 contingency table with calculation of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), overall accuracy, and intramodality agreement. Results: CTA identified stenosis in 64 (53.3%) patients, while CDUS was positive in 68 (56.7%). CDUS yielded 60 true-positive, 48 true-negative, 8 false-positive, and 4 false-negative findings. Sensitivity was 93.8% (95% CI, 85.0–97.5), specificity 85.7% (74.3–92.6), PPV 88.2% (78.5–93.9), NPV 92.3% (81.8–97.0), and overall accuracy 90.0% (83.3–94.2). Cohen’s κ was 0.80, indicating substantial agreement. Conclusion: CDUS demonstrated high sensitivity, good specificity, and substantial agreement with CTA, supporting its use as a noninvasive initial modality for evaluating carotid artery stenosis in patients with cerebral ischemic events
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