B-mode, real-time carotid ultrasonic imaging. Correlation with angiography.

B-mode, real-time ultrasonic imaging was prospectively evaluated as a screening test for atherosclerotic occlusive vascular disease in the carotid bifurcation region, as defined by carotid angiography in 100 carotid systems in 50 patients. Preliminary reliability studies for each technique assessed agreement between examiners. Sensitivities of ultrasonography for stenosis greater than 50% of luminal diameter, complicated plaque ulceration, complete occlusion, and "surgical disease" by any of these parameters were 79%, 26%, 25%, and 73%, respectively. Thirty-seven percent of the 100 carotid systems were found to contain surgically relevant disease by angiography, compared with 19% and 56%, respectively, of the carotid systems with negative and positive ultrasonographic results. Judicious use of ultrasonography as a screen for angiography requires awareness of these limitations.