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  • 1
    Online Resource
    Online Resource
    Abstract WP233: Validation of Multi-parametric Ultrasonography Criteria With Catheter Angiography in Internal Carotid Artery Disease: a Multicenter Study
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Introduction: Novel multi-parametric criteria for duplex ultrasonography (DUS) grading of extracranial internal carotid artery (ICA) steno-occlusive disease have been recently introduced by the German ultrasound expert panel (DEGUM). We sought to determine diagnostic accuracy of the DEGUM criteria against the gold standard catheter angiography. Methods: We prospectively enrolled consecutive patients who routinely underwent diagnostic or therapeutic catheter angiography of the extracranial carotid arteries in four German study sites. Internal carotid artery disease was graded according to the DEGUM multi-parametric criteria for DUS. On angiography, extracranial ICA disease was graded using the NASCET approach. Ultrasonography and endovascular raters were blinded to clinical data and any other imaging modalities. To correspond to clinically relevant NASCET groups, all stenosis measurements were stratified into ranges: normal, mild (1-49%), moderate (50-69%), severe (70-99%) and occlusion. Results: We studied 130 patients who underwent both DUS and catheter angiography for assessment of carotid arteries (mean age, 64±11 years; 67% men; median time between DUS and angiography, 1 day [interquartile range, 2.5]). To date, fifty-two carotid artery pairs were independently rated and available for comparative analysis. Compared with catheter angiography, DUS had the following positive (PPV) and negative predictive values (NPV): PPV 50% and NPV 72% (3 true positive, 3 false positive, 33 true negative, 13 false negative) for detection of moderate, and PPV 57% and NPV 77% (20 true positive, 15 false positive, 13 true negative, 4 false negative) for detection of severe stenosis. Conclusions: Our preliminary data indicate that the novel DEGUM multi-parametric ultrasonography criteria do not eliminate the need for a confirmatory test for identification of clinically relevant grades of extracranial ICA disease.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.wp233
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1467823-8
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  • 2
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    Online Resource
    Validation of Multiparametric Ultrasonography Criteria with Digital Subtraction Angiography in Carotid Artery Disease: A Prospective Multicenter Study
    Georg Thieme Verlag KG ; 2018
    In:  Ultraschall in der Medizin - European Journal of Ultrasound Vol. 39, No. 05 ( 2018-10), p. 535-543
    Details
    In: Ultraschall in der Medizin - European Journal of Ultrasound, Georg Thieme Verlag KG, Vol. 39, No. 05 ( 2018-10), p. 535-543
    Abstract: Purpose The German Society of Ultrasound in Medicine (DEGUM) recently revised its multiparametric criteria for duplex ultrasonography (DUS) grading of internal carotid artery (ICA) disease. We determined the diagnostic accuracy of the revised DEGUM criteria for ultrasonography grading of ICA disease in a prospective multicenter study. Materials and Methods We evaluated consecutive patients who underwent digital subtraction angiography of the extracranial carotid arteries at four tertiary care hospitals. Blinded investigators graded ICA disease according to DEGUM-recommended ultrasonography criteria and calculated NASCET-type percent stenosis from angiography images. Endpoints included overall classification accuracy, prediction of clinically relevant disease categories and between-test agreement in the continuous range of percent stenosis. Results A total of 121 patients (median age: 69 [IQR, 16] years; 74 % men; median time between DUS and angiography: 1 day [IQR, 2] ) provided 163 DUS-angiography carotid artery pairs. The classification accuracy of the DEGUM criteria to predict stenosis within 10 % increments as compared to angiography was 34.9 % (95 % CI, 28.0 – 42.6). The sensitivity of DUS for the detection of moderate (50 – 69 %) and severe (70 – 99 %) stenosis was 35 % and 81 %, with an overall accuracy of 73 % and 74 %, respectively. The specificity was 89 % and 69 %, respectively. Considering the continuous spectrum of the disease (0 – 100 %), the Bland-Altman interval limit of agreement was 51 %. Conclusion At laboratories experienced with ultrasound grading of the extracranial ICA, the revised DEGUM multiparametric ultrasonography criteria do not eliminate the need for a confirmatory test for the identification of clinically relevant grades of the disease.
    Type of Medium: Online Resource
    ISSN: 0172-4614 , 1438-8782
    URL: Article
    DOI: 10.1055/s-0043-119355
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2018
    detail.hit.zdb_id: 2028670-3
    SSG: 12
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  • 3
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    Online Resource
    Abstract TMP32: Ultrasonography Grading of Internal Carotid Artery Disease: Multi-Parametric DEGUM versus SRU Consensus Criteria
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. suppl_1 ( 2017-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. suppl_1 ( 2017-02)
    Abstract: Introduction: The novel multi-parametric ‘DEGUM’ duplex ultrasonography (DUS) criteria may improve accuracy of extracranial carotid artery grading but have not been compared with the established Society of Radiologists in Ultrasound (SRU) consensus criteria yet. We sought to investigate the diagnostic agreement between these two widely used DUS approaches for grading of carotid artery steno-occlusive disease. Methods: This was a sub-analysis of the complete dataset from a prospective multicenter study, where a total of 120 patients underwent both DUS and catheter angiography for validation of the multi-parametric DEGUM ultrasound approach. In this analysis, two ultrasonography experts independently interpreted documented B-image, color-flow and Doppler spectra findings utilizing DEGUM and SRU criteria. Carotid arteries were categorized into clinically relevant NASCET strata: moderate (50-69%), severe (70-99%) and occlusion. On angiography, ICA was graded using the NASCET approach. Inter-rater and between-methods reliability was assessed through weighted Cohen’s kappa. Overall accuracy for both ultrasound approaches was computed using catheter angiography as the gold standard. Results: We analyzed a total of 162 carotid artery pairs on catheter angiography and DUS. There was almost perfect agreement between both ultrasonography diagnostic approaches in describing all clinically relevant grades of the disease (k w 0.91, CI95%: 0.89-0.94). Inter-rater reliability was found to be comparably high for both the DEGUM (k w 0.97, CI95%: 0.94-0.98) and the SRU (k w 0.98, CI95%: 0.97-0.99) ultrasonography approaches. Compared with catheter angiography, overall accuracy for moderate and severe stenosis ranges did not differ between the DEGUM (73% and 73%, respectively) and the SRU (73% and 70%, respectively) approaches. There was also no difference for detection of carotid artery occlusion (96% and 96%, respectively). Conclusions: Our analysis showed almost perfect diagnostic agreement between the DEGUM and the SRU approaches for ultrasonography grading of carotid artery steno-occlusive disease. Therefore, our data do not support superiority of one approach over the other in the evaluation of clinically relevant grades of the disease.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.48.suppl_1.tmp32
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
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  • 4
    Online Resource
    Online Resource
    Abstract WP130: Validation of Multi-parametric Ultrasonography Criteria with Catheter Angiography in Internal Carotid Artery Disease: A Prospective Multicenter Study
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. suppl_1 ( 2017-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. suppl_1 ( 2017-02)
    Abstract: Introduction: Novel multi-parametric criteria for duplex ultrasonography (DUS) grading of extracranial internal carotid artery (ICA) steno-occlusive disease have been recently introduced by the German ultrasound expert panel (DEGUM). We sought to determine diagnostic accuracy of the DEGUM criteria against the gold standard catheter angiography. Methods: We prospectively enrolled consecutive patients who routinely underwent diagnostic or therapeutic catheter angiography of the extracranial carotid arteries at four German study sites. Internal carotid artery disease was graded according to the DEGUM multi-parametric criteria for DUS. On angiography, extracranial ICA disease was graded using the NASCET approach. Ultrasonography and endovascular raters were blinded to clinical data and any other imaging modalities. To correspond to clinically relevant NASCET groups, all stenosis measurements were stratified into ranges: normal, mild (1-49%), moderate (50-69%), severe (70-99%) and occlusion. Results: A total of 120 patients (median age, 69 [IQR, 16] years; 74% men; median time between DUS and angiography, 1 day [IQR, 2.5] ) provided 162 DUS/angiography carotid artery pairs for final analysis. On angiography, moderate stenosis was found in 48 (30%) and severe stenosis in 63 (39%) arteries. Sensitivity of DUS for detection of moderate and severe stenosis was 35% (95%CI, 22-51%) and 81% (69-90%), with a NPV of 77% (68-84%) and 85% (75-92%), respectively. Specificity was 89% (81-94%) and 97% (94-99%), with a PPV of 57% (37-75%) and 62% (51-73%), respectively. Considering the entire spectrum of the disease (0-100%), the Bland-Altman interval limit of agreement was 51% (Figure). Conclusions: At laboratories experienced with ultrasound grading of the extracranial ICA, the novel DEGUM multi-parametric ultrasonography criteria do not eliminate the need for a confirmatory test for identification of clinically relevant grades of the disease.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.48.suppl_1.wp130
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
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  • 5
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    Online Resource
    Ultrasonography Grading of Internal Carotid Artery Disease: Multiparametric German Society of Ultrasound in Medicine (DEGUM) versus Society of Radiologists in Ultrasound (SRU) Consensus Criteria
    Georg Thieme Verlag KG ; 2022
    In:  Ultraschall in der Medizin - European Journal of Ultrasound Vol. 43, No. 06 ( 2022-12), p. 608-613
    Details
    In: Ultraschall in der Medizin - European Journal of Ultrasound, Georg Thieme Verlag KG, Vol. 43, No. 06 ( 2022-12), p. 608-613
    Abstract: Purpose We sought to determine the diagnostic agreement between the revised ultrasonography approach by the German Society of Ultrasound in Medicine (DEGUM) and the established Society of Radiologists in Ultrasound (SRU) consensus criteria for the grading of carotid artery disease. Materials and Methods Post-hoc analysis of a prospective multicenter study, in which patients underwent ultrasonography and digital subtraction angiography (DSA) of carotid arteries for validation of the DEGUM approach. According to DEGUM and SRU ultrasonography criteria, carotid arteries were independently categorized into clinically relevant NASCET strata (normal, mild [1–49 %] , moderate [50–69 %], severe [70–99 %] , occlusion). On DSA, carotid artery findings according to NASCET were considered the reference standard. Results We analyzed 158 ultrasonography and DSA carotid artery pairs. There was substantial agreement between both ultrasonography approaches for severe (κw 0.76, CI95 %: 0.66–0.86), but only fair agreement for moderate (κw 0.38, CI95 %: 0.19–0.58) disease categories. Compared with DSA, both ultrasonography approaches were of equal sensitivity (79.7 % versus 79.7 %; p = 1.0) regarding the identification of severe stenosis, yet the DEGUM approach was more specific than the SRU approach (70.2 % versus 56.4 %, p = 0.0002). There was equality of accuracy parameters (p  〉  0.05) among both ultrasonography approaches for the other ranges of carotid artery disease. Conclusion While the sensitivity was equivalent, false-positive identification of severe carotid artery stenosis appears to be more frequent when using the SRU ultrasonography approach than the revised multiparametric DEGUM approach.
    Type of Medium: Online Resource
    ISSN: 0172-4614 , 1438-8782
    URL: Article
    DOI: 10.1055/a-1487-5941
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2022
    detail.hit.zdb_id: 2028670-3
    SSG: 12
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  • 6
    Online Resource
    Online Resource
    Prothrombin Gene G 20210 →A Transition Is a Risk Factor for Cerebral Venous Thrombosis
    Ovid Technologies (Wolters Kluwer Health) ; 1998
    In:  Stroke Vol. 29, No. 9 ( 1998-09), p. 1765-1769
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 29, No. 9 ( 1998-09), p. 1765-1769
    Abstract: Background and Purpose —It has been recently reported that a G→A transition at nucleotide position 20210 in the 3′-untranslated region of the prothrombin gene is associated with elevated plasma prothrombin levels and an increased risk of deep venous thrombosis. To date, it is unknown whether this polymorphism also represents a risk factor for cerebral venous thrombosis (CVT). Methods —Venous blood samples were collected from 45 patients with CVT and from 354 healthy blood donors as controls. A second control group consisted of 131 subjects with acute ischemic stroke or transient ischemic attack (TIA). Genomic DNA was isolated from peripheral blood leukocytes. Amplification of DNA was performed by polymerase chain reaction (PCR). The G→A transition at nucleotide position 20210 of the prothrombin gene was detected by allele-specific restriction digestion. Results —The G 20210 →A transition in the prothrombin gene was found in a heterozygous form in 4 of 45 patients with CVT (8.9%) and in 8 of 354 healthy control subjects (2.3%). This difference was statistically significant ( P =0.010). The G 20210 →A transition increased the relative risk for CVT approximately 5-fold (age-adjusted odds ratio 5.7; 95% CI 1.5 to 21.5). In contrast, in the group of patients with acute cerebral ischemia, only 3 of 131 subjects (2.3%) were heterozygous for the G 20210 →A transition, which corresponded to the prevalence in the group of healthy blood donors. Conclusions —The recently described G 20210 →A transition in the 3′-untranslated region of the prothrombin gene is an inherited risk factor for CVT but obviously not for acute ischemic stroke or TIA.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.29.9.1765
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 1998
    detail.hit.zdb_id: 1467823-8
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