Tuesday, November 29 | 1:30 p.m.-2:30 p.m. | T6-SSNR08-5 | E350
The effects of revised guidelines for the use of carotid Doppler ultrasound in diagnosing internal carotid artery stenosis will be discussed in this RSNA presentation.Traditionally, the suggested range for diagnosis of a moderate, 50 to 69% stenosis had been peak systolic velocity measurements between 125 cm/s and 229 cm/s. These recommendations were established in 2003 by the Society of Radiologists in Ultrasound. However, the Intersocietal Accreditation Commission has expressed concern in recent years that these suggested measures are too broad. As a result, the commission narrowed this range for moderate stenosis to 180 cm/s to 229 cm/s.
Researchers led by Dr. Shima Tafreshi from Northwell Health in White Plains, NY, looked at a total of 15,810 carotid arteries for 7,905 patients. They found that of the 1,311 carotid arteries previously classified as moderate, the new parameters eliminated 1,054. This meant only 257 remained "moderate."
Also, the ratio between internal carotid artery and common carotid artery (ICA/CCA) greater than two was found in 34% of patients with peak systolic velocity between 125 cm/s and 179 cm/s. Meanwhile, an ICA/CCA ratio greater than two was found in 75% of patients with velocity greater than 180 cm/s.
"This is further evidence that the prior range was too broad," authors wrote.
Find out more in this Tuesday session.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
