Ultrasonic imaging in the diagnosis of carotid vascular disease with attention to operated upon nonangiographic lesions.

Two thousand carotid arteries were evaluated by B-mode real-time ultrasound, Doppler ultrasound, carotid phonoangiography, and oculoplethysmography. All patients were referred for evaluation of asymptomatic bruits, transient ischemic attacks, or stroke. Angiography was performed on 760 vessels and operative intervention upon 248 arteries. B-mode correctly identified 123/126 vessels said to be normal by angiography; it identified nonstenotic plaques in 296 vessels where angiography only noted 288 instances of nonstenotic plaque. In 341/346 vessels, lesions greater than 50 per cent stenosis were correctly identified by B-mode. Compared with angiography, B-mode ultrasound has a sensitivity of 98.5 per cent for greater than 50 per cent stenosis and a specificity of 100 per cent. For lesions less than 50 per cent stenotic, B-mode has a sensitivity of 100 per cent, a specificity of 98.3 per cent, and a calculated accuracy of 98.9 per cent.