(Ultrasound Review) The Journal of Vascular Surgery recently published an article regarding duplex ultrasound of aortoiliac and femoropoliteal arteries. The purpose of the March study was to determine the interobserver variability of aortoiliac and femoropopliteal duplex scanning for patients with peripheral arterial atherosclerosis.
In order for duplex ultrasound to be utilized in clinical decision making, the modality needs to demonstrate high accuracy and low interobserver variability. At the Academic Medical Center in Amsterdam, Netherlands, they scanned 61 consecutive patients, measured the peak systolic velocities (PSV), and calculated the ratios in the same defined segment.
At this vascular clinic, a PSV ratio of 2.5 was used to diagnose a stenosis of 50% or greater. Specific attention was placed on peak systolic velocity measurements and corresponding ratios that indicated borderline arterial stenosis.
A comparison of results demonstrated that the interobserver agreement for the aortoiliac vessels was 85%, and for the femeropopliteal vessels the agreement was 87%. There was marked variation in interobserver agreement when the PSV ratio was in the higher range. Two separate investigations were performed for the aortoiliac vessels because the initial analysis showed such disappointing results, but the second series showed similar poor results.
For the aortoiliac and femoropoliteal arteries, duplex ultrasound showed a moderate interobserver agreement. The authors recommended "repetition of the measurement or additional diagnostics" particularly for patients with borderline stenosis where a clinical decision making could lead to surgical intervention or conversely conservative surveillance.
They predicted that by repeating the PSV measurements and ratios using a different operator the accuracy should be improved. "Interobserver variation increased markedly with increasing PSV ratio. In the PSV ratio category between 2.0 to 3.0, indicating a borderline stenosis, a substantial disagreement was found," the authors stated.
"Interobserver variability in aortoiliac and femoropopliteal duplex scanning"D.T. Ubbink et al
Department of Vascular Surgery, Academic Medical Center, Amsterdam, The Netherlands
Journal of Vascular Surgery; March 2001; 33: 540–545
By Ultrasound Review
June 21, 2001
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