Acurácia da Ecografia Vascular com Doppler comparado à Angiotomografia para o diagnóstico de estenose de carótida interna extracraniana
Data
2023-08-02
Autores
Daolio, Raul Muffato 
Orientadores
Flumignan, Ronald Luiz Gomes
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: Estenoses de artéria carótida interna (ACI) são causas importantes de acidentes vasculares cerebrais (AVCs). A Ecografia Vascular com Doppler (EVD) costuma ser o primeiro exame a ser realizado durante sua investigação, mas possui acurácia variável na literatura e é comum complementar o estudo com a realização de outro exame quando frente a uma estenose com possibilidade de tratamento cirúrgico. Há carência de estudos de acurácia comparando a EVD com angiotomografia (ATC) na literatura. Métodos: Foi realizado um estudo de acurácia no qual se comparou a EVD com as ATCs de carótida de pacientes da EPM/UNIFESP realizadas em um mesmo período. Incluiu-se pacientes que realizaram ambos exames em um período de até 3 meses. As imagens foram avaliadas independentemente por 2 cirurgiões vasculares e, se houvesse divergência entre eles, um terceiro arbitrou o resultado. Realizou-se análise estatística determinando a acurácia, sensibilidade e especificidade de estenoses nas faixas de 50-99% e 70-99%. Também foi realizada a análise de discordância entre avaliadores de um mesmo exame para se comparar uma técnica à outra. Resultados: Foram incluídos nas análises estatísticas 45 pacientes e 84 artérias. Para estenoses 50-99% obteve-se acurácia de 69%, sensibilidade 89% e especificidade 63%. Para estenoses 70-99% obteve-se acurácia de 84%, sensibilidade de 61% e especificidade de 93%. A área sob a curva ROC é de 0,868. Ocorreu discordância entre avaliadores de ATC com mudança de conduta clínica para cirúrgica em pelo menos 37,5% dos laudos conflitantes. Conclusão: A acurácia da EVD para estenoses entre 50-99% é de 69%. Para estenoses entre 70-99% a acurácia é de 84%. A área sob a curva ROC é de 0,868. A EVD pode ser usada exclusivamente para indicar endarterectomia de carótida desde que seja realizado um segundo exame para confirmação. Análises de ATC podem ser dependentes do avaliador a ponto de mudar a conduta.
Introduction: Internal carotid artery (ICA) stenosis are important causes of stroke. Duplex ultrasound scan (DUS) is the first line of investigation, but its accuracy varies on literature and it is usual to complement the study with another exam with higher accuracy when facing a significant stenosis. There is a lack of studies comparing DUS with CT angiography (CTA) in the present literature. Methods: We performed an accuracy study, which compared DUS to Carotid CTAs of EPM/UNIFESP patients in the same period. The patients were selected retrospectively and two independent vascular surgeons evaluated both images. All of them were blinded for the others' analysis. When necessary, a third evaluator was summoned. The statistics included the accuracy of stenosis 50-99% and 70-99%. Discordance between evaluators from each exam was also fulfilled. Results: We included 45 patients and 84 arteries after exclusion criteria applied. For 50-99% stenosis: accuracy 69%, sensibility 89%, and specificity 63%. For stenosis 70-99% accuracy 84%, sensibility 61%, specificity 93%. Area under the ROC curve is 0,868. Discordance between CTA evaluators that represented chance on clinical or surgical approach was 37,5% of the conflicting arteries. Conclusion: The accuracy of DUS for 50-99% range of stenosis is 69%. For 70-99% range of stenosis is 84%. Area under the ROC curve is 0,868. DUS can be used exclusively for indicate carotid endarterectomy since a second exam is performed for confirmation. CTAs analysis could be evaluator-dependent and lead to change of conduct.
Introduction: Internal carotid artery (ICA) stenosis are important causes of stroke. Duplex ultrasound scan (DUS) is the first line of investigation, but its accuracy varies on literature and it is usual to complement the study with another exam with higher accuracy when facing a significant stenosis. There is a lack of studies comparing DUS with CT angiography (CTA) in the present literature. Methods: We performed an accuracy study, which compared DUS to Carotid CTAs of EPM/UNIFESP patients in the same period. The patients were selected retrospectively and two independent vascular surgeons evaluated both images. All of them were blinded for the others' analysis. When necessary, a third evaluator was summoned. The statistics included the accuracy of stenosis 50-99% and 70-99%. Discordance between evaluators from each exam was also fulfilled. Results: We included 45 patients and 84 arteries after exclusion criteria applied. For 50-99% stenosis: accuracy 69%, sensibility 89%, and specificity 63%. For stenosis 70-99% accuracy 84%, sensibility 61%, specificity 93%. Area under the ROC curve is 0,868. Discordance between CTA evaluators that represented chance on clinical or surgical approach was 37,5% of the conflicting arteries. Conclusion: The accuracy of DUS for 50-99% range of stenosis is 69%. For 70-99% range of stenosis is 84%. Area under the ROC curve is 0,868. DUS can be used exclusively for indicate carotid endarterectomy since a second exam is performed for confirmation. CTAs analysis could be evaluator-dependent and lead to change of conduct.