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Inter-sonographer reproducibility of carotid ultrasound plaque detection using Mannheim consensus in subclinical atherosclerosis
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.ORCID iD: 0000-0002-4060-4752
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.ORCID iD: 0000-0003-2078-3658
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
2020 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 40, no 1, p. 46-51Article in journal (Refereed) Published
Abstract [en]

Aims: To determine the inter-sonographer reproducibility of carotid ultrasound plaque detection using Mannheim consensus in a subclinical population and evaluate associations related to the reproducibility.

Methods and results: Bilateral ultrasound screening for carotid plaques defined by Mannheim consensus was performed on 106 subclinical participants. Two different sonographers scanned the same participant, and reproducibility of plaque detection was measured by Cohens kappa. Associations with reproducibility were evaluated by comparing wall, and plaque characteristics between subjects with plaques identified in one and both scans. In general, the inter-sonographer reproducibility of plaque detection was substantial with a kappa value of 0 center dot 70 (95% CI 0 center dot 60-0 center dot 80). Plaques detected in only one scan had significantly lower plaque area and plaque thickness (6 center dot 82 mm(2) and 1 center dot 45 mm) as compared to plaques detected in both scans (11 center dot 65 mm(2) and 1 center dot 96 mm, P<0 center dot 001).

Conclusion: Minor carotid plaques contribute to decreased reproducibility as compared to large plaques when screening for subclinical atherosclerosis using Mannheim consensus. Using an alternative plaque definition based on plaque thickness >1.5 mm and plaque area >10 mm(2) could increase the reproducibility of plaque detection in subclinical atherosclerosis.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020. Vol. 40, no 1, p. 46-51
Keywords [en]
carotid, inter-sonographer, plaque, reproducibility, subclinical, ultrasound
National Category
Physiology
Identifiers
URN: urn:nbn:se:umu:diva-165443DOI: 10.1111/cpf.12602ISI: 000493037200001PubMedID: 31605665Scopus ID: 2-s2.0-85074818346OAI: oai:DiVA.org:umu-165443DiVA, id: diva2:1373615
Available from: 2019-11-27 Created: 2019-11-27 Last updated: 2023-03-23Bibliographically approved
In thesis
1. Ultrasound measurements of subclinical carotid atherosclerosis: methodological and clinical studies
Open this publication in new window or tab >>Ultrasound measurements of subclinical carotid atherosclerosis: methodological and clinical studies
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Mätning av tidig ateroskleros genom ultraljud : metodologiska och kliniska studier
Abstract [en]

Ultrasound measurements of subclinical carotid atherosclerosis have been evaluated as an additional parameter in risk evaluation of cardiovascular diseases (CVD). The overall aim of this thesis was to increase knowledge regarding ultrasound measurements of subclinical carotid atherosclerosis. This included methodological studies of the reproducibility in commonly applied measurements and evaluation of subclinical carotid atherosclerotic progression. All studies within this thesis are based on material from the population based, randomized control trial VIPVIZA. Enrolled from a routine CVD prevention programme, all participants had an additional carotid ultrasound examination including measurements of carotid intima media thickness (cIMT) and carotid plaque detection. The group randomised to the intervention received a pictorial presentation which illustrating their individually measured subclinical atherosclerotic burden. At the 3-year follow-up the same measurements were repeated.

Variability, defined by variation of coefficient (CV) of measurements, of plaque risk markers including echogenicity and plaque area were evaluated throughout the cardiac cycle. Additionally, the inter-observer reproducibility of plaque detection was evaluated, and the intervention effect on the 3-year cIMT and plaque progression was compared between intervention (n: 1575)  and control group (n: 1579). Lastly, association of baseline carotid wall echogenicity and the 3-year progression of cIMT was evaluated. Small and echolucent plaques had higher CV in measurements of area and echogenicity, respectively. Cardiac cycle variations caused reclassification of up to one in four of the analysed plaques. Small carotid plaques contributed to decreased inter-sonographer reproducibility as compared to large plaques. In the 3-year follow-up the intervention group showed decreased progression of cIMT in the left carotid compared to the control group. No difference was found for in plaque related variables. The echogenicity of the carotid wall associated with the progression of cIMT over the 3-year follow-up period, where echolucent carotid wall had a higher rate of progression bilaterally.

Variability of plaque risk markers and the reproducibility of plaque detection should be considered in analysis of subclinical carotid atherosclerosis by ultrasound. Progression of left cIMT was decreased by the intervention, which indicates that increased preventive actions were taken by the intervention group. The echogenicity of the carotid wall may contribute new insights regarding identification of progressive atherosclerotic diseases.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2021. p. 73
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2152
Keywords
atherosclerosis, ultrasound, carotid artery, carotid intima media thickness, carotid plaque, reproducibility, intervention, echogenicity
National Category
Cardiac and Cardiovascular Systems
Research subject
cardiovascular disease
Identifiers
urn:nbn:se:umu:diva-187756 (URN)978-91-7855-630-4 (ISBN)978-91-7855-629-8 (ISBN)
Public defence
2021-10-15, Bergasalen, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2021-09-24 Created: 2021-09-21 Last updated: 2021-09-21Bibliographically approved

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Nyman, EmmaVanoli, DavideNäslund, UlfGrönlund, Christer

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