Brown O William, Bendick Phillip J, Bove Paul G, Long Graham W, Cornelius Patricia, Zelenock Gerald B, Shanley Charles J
Department of Surgery, William Beaumont Hospital, Royal Oak, MI 48037, USA.
J Vasc Surg. 2004 Feb;39(2):366-71; discussion 371. doi: 10.1016/j.jvs.2003.08.018.
The purpose of this study was to evaluate the reliability of carotid duplex ultrasound scanning performed by nonaccredited vascular laboratories and to assess the clinical effect on patient management.
We retrospectively reviewed concordance of findings of carotid duplex ultrasound scanning between laboratories accredited by the Intersocietal Commission for Accreditation of Vascular Laboratories and nonaccredited laboratories in 174 patients with asymptomatic disease referred to tertiary care community hospitals for surgical evaluation for carotid endarterectomy (CEA) between January 2001 and December 2002, and evaluated changes in clinical management made on the basis of repeat examinations.
Concordant findings were noted in 171 of 348 arteries (49%), predominantly those with minimal or mild disease (114 arteries; 67%). Discordant findings of no clinical significance were found in 54 arteries (16%). Clinically significant discordant findings were noted in 123 arteries (35%) in 107 patients (61%). In 104 arteries (88 patients) stenosis was overestimated by the nonaccredited laboratory secondary to technical error (19 arteries), use of B-mode imaging data alone (36 arteries), and use of inappropriate velocity criteria (49 arteries). None of these patients underwent CEA. Stenosis was significantly underestimated in 19 arteries (19 patients); all of these patients underwent uncomplicated CEA.
Incorrect physician interpretation of data is the most common cause of error in carotid duplex ultrasound scanning performed in nonaccredited vascular laboratories. Results of carotid duplex ultrasound scanning from nonaccredited laboratories should be considered with extreme caution, and do not appear reliable in planning treatment of obstructive disease.
本研究旨在评估由未获认证的血管实验室进行的颈动脉双功超声扫描的可靠性，并评估其对患者管理的临床影响。
我们回顾性分析了2001年1月至2002年12月期间转诊至三级医疗社区医院接受颈动脉内膜切除术（CEA）手术评估的174例无症状疾病患者中，血管实验室认证协会认证的实验室与未获认证的实验室之间颈动脉双功超声扫描结果的一致性，并评估基于重复检查所做出的临床管理变化。
348条动脉中有171条（49%）结果一致，主要是那些病变轻微或轻度的动脉（114条动脉；67%）。54条动脉（16%）发现了无临床意义的不一致结果。107例患者（61%）的123条动脉（35%）发现了具有临床意义的不一致结果。在104条动脉（88例患者）中，未获认证的实验室因技术错误（19条动脉）、仅使用B模式成像数据（36条动脉）和使用不适当的速度标准（49条动脉）而高估了狭窄程度。这些患者均未接受CEA。19条动脉（19例患者）的狭窄程度被显著低估；所有这些患者均接受了无并发症的CEA。
在未获认证的血管实验室进行的颈动脉双功超声扫描中，医生对数据的错误解读是最常见的错误原因。来自未获认证实验室的颈动脉双功超声扫描结果应极其谨慎地考虑，并且在规划阻塞性疾病的治疗时似乎不可靠。
