Evidence map›Paper›PMID 40639748›Full record

ArticleJournal of vascular surgery2025

Duplex ultrasound may lead to misclassification of carotid artery stenosis.

Raza Mushtaq, Summan Zahra, Scott French, Juan C Arias, Ryan Forney, Lindsay Taylor, Gavin Culwell, Kevin Johnson, Maria Altbach, Craig C Weinkauf

Abstract readComparative Study
In one paragraph

Article in Journal of vascular surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Raza MushtaqDepartment of Neuroradiology, Barrow Neurological Institute, Phoenix, AZ.
Summan ZahraDivision of Vascular Surgery, University of Arizona, Tucson, AZ.
Scott FrenchDivision of Vascular Surgery, University of Arizona, Tucson, AZ.
Juan C AriasDivision of Vascular Surgery, University of Arizona, Tucson, AZ.
Ryan ForneyDepartment of Radiology, Creighton University School of Medicine, Phoenix, AZ.
Lindsay TaylorDepartment of Radiology, Creighton University School of Medicine, Phoenix, AZ.
Gavin CulwellDivision of Vascular Surgery, University of Arizona, Tucson, AZ.
Kevin JohnsonDepartment of Medical Imaging, University of Arizona, Tucson, AZ.
Maria AltbachDepartment of Medical Imaging, University of Arizona, Tucson, AZ.
Craig C WeinkaufDivision of Vascular Surgery, University of Arizona, Tucson, AZ. Electronic address: cweinkauf@surgery.arizona.edu.

Funding

Research Education ComponentP30AG072980 · NIA · BANNER HEALTH · PI ALIREZA ATRI · 2021 to 2026
$24.9M
Improvement of Overall recruitment, Latino Community Outreach and MRI acquisitionR01AG070987 · NIA · UNIVERSITY OF ARIZONA · PI WEINKAUF, CRAIG C · 2021 to 2025
$6.5M
Multi-Center Implementation and Validation of Efficient Magnetic Resonance Imaging and Analysis of Atherosclerotic Disease of the Cervical CarotidR01HL159200 · NHLBI · UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH · PI ALTBACH, MARIA I., DESHPANDE, VIBHAS · 2021 to 2025
$6.1M
NHLBI NIH HHS R01 HL159200NIA NIH HHS P30 AG072980NIA NIH HHS R01 AG070987
6 · The paper itself

Abstract

objectiveCarotid duplex ultrasonography (CDUS) is often the first-line imaging modality for clinical evaluation of carotid disease. Despite improved equipment and standardization of vascular imaging protocols, CDUS can be technician-dependent and unreliable in calcified blood vessels. The aim of this study was to assess variability in carotid stenosis severity measured using CDUS compared with reference high-resolution magnetic resonance imaging (MRI).

methodsIn this prospective cohort study designed to study long-term brain health outcomes, we enrolled 123 participants with a diagnosis of asymptomatic carotid disease and/or ≥2 cardiovascular risk factors between the ages of 50 to 85 years from vascular and cardiology clinics in Tucson, Arizona, for the ongoing Carotids and Minds (CAM) study. Using a specialized radiofrequency coil for carotid imaging, high-resolution time-of-flight (0.63 × 0.63 × 1.0 mm

resultsA total of 246 carotid arteries were evaluated for percent stenosis using both MRI and clinical CDUS imaging. Twenty-five percent of the carotid arteries with severe (70%-99%) stenosis based on MRI were misclassified as having mild (<50%) or moderate (50%-69%) stenosis based on CDUS. Conversely, 33% of arteries with mild disease were overestimated by CDUS into higher stenosis categories. For detecting ≥70% carotid stenosis, clinical CDUS had a sensitivity of 0.77 (95% confidence interval, 0.67-0.87) and specificity of 0.92 (95% confidence interval, 0.88- 0.96), indicating a false negative rate of 23%.

conclusionsCDUS provides a rapid, noninvasive assessment of carotid disease in clinical settings, yet in this cohort, it misclassified carotid stenosis severity (both over and under) 32% of the time. Thus, reliance on CDUS alone could lead to inappropriate treatment decisions. High-resolution MR angiography or computed tomography angiography should be considered for more accurate stratification of disease severity in patients with asymptomatic carotid disease.

Indexed as

Carotid ArteriesCarotid StenosisUltrasonography, Doppler, DuplexAgedAged, 80 and overAsymptomatic DiseasesFemaleHumansMagnetic Resonance AngiographyMagnetic Resonance ImagingMaleMiddle AgedObserver VariationPredictive Value of TestsProspective StudiesReproducibility of ResultsAsymptomatic extracranial carotid atherosclerotic diseaseCarotid diseaseCarotid duplex ultrasonographyCarotid magnetic resonance imagingCarotid stenosis

Identifiers

PMID40639748
PMCPMC12575209

What Socratic holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.