{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T17:13:12Z","timestamp":1793812392420,"version":"4.6.1"},"reference-count":26,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2021,5,19]],"date-time":"2021-05-19T00:00:00Z","timestamp":1621382400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Vasc Med"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:p>Diagnostic criteria to classify severity of internal carotid artery (ICA) stenosis vary across vascular laboratories. Consensus-based criteria, proposed by the Society of Radiologists in Ultrasound in 2003 (SRUCC), have been broadly implemented but have not been adequately validated. We conducted a multicentered, retrospective correlative imaging study of duplex ultrasound versus catheter angiography for evaluation of severity of ICA stenosis. Velocity data were abstracted from bilateral duplex studies performed between 1\/1\/2009 and 12\/31\/2015 and studies were interpreted using SRUCC. Percentage ICA stenosis was determined using North American Symptomatic Carotid Endarterectomy Trial (NASCET) methodology. Receiver operating characteristic analysis evaluated the performance of SRUCC parameters compared with angiography. Of 448 ICA sides (from 224 patients), 299 ICA sides (from 167 patients) were included. Agreement between duplex ultrasound and angiography was moderate (\u03ba = 0.42), with overestimation of degree of stenosis for both moderate (50\u201369%) and severe (\u2a7e 70%) ICA lesions. The primary SRUCC parameter for \u2a7e 50% ICA stenosis of peak-systolic velocity (PSV) of \u2a7e 125 cm\/sec did not meet prespecified thresholds for adequate sensitivity, specificity, and accuracy (sensitivity 97.8%, specificity 64.2%, accuracy 74.5%). Test performance was improved by raising the PSV threshold to \u2a7e 180 cm\/sec (sensitivity 93.3%, specificity 81.6%, accuracy 85.2%) or by adding the additional parameter of ICA\/common carotid artery (CCA) PSV ratio \u2a7e 2.0 (sensitivity 94.3%, specificity 84.3%, accuracy 87.4%). For \u2a7e 70% ICA stenosis, analysis was limited by a low number of cases with angiographically severe disease. Interpretation of carotid duplex examinations using SRUCC resulted in significant overestimation of severity of ICA stenosis when compared with angiography; raising the PSV threshold for \u2a7e 50% ICA stenosis to \u2a7e 180 cm\/sec as a single parameter or requiring the ICA\/CCA PSV ratio \u2a7e 2.0 in addition to PSV of \u2a7e 125 cm\/sec for laboratories using the SRUCC is recommended to improve the accuracy of carotid duplex examinations.<\/jats:p>","DOI":"10.1177\/1358863x211011253","type":"journal-article","created":{"date-parts":[[2021,5,19]],"date-time":"2021-05-19T09:41:33Z","timestamp":1621417293000},"page":"515-525","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":44,"title":["Optimization of duplex velocity criteria for diagnosis of internal carotid artery (ICA) stenosis: A report of the Intersocietal Accreditation Commission (IAC) Vascular Testing Division Carotid Diagnostic Criteria Committee"],"prefix":"10.1177","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5849-4010","authenticated-orcid":false,"given":"Heather L","family":"Gornik","sequence":"first","affiliation":[{"name":"Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatjana","family":"Rundek","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Gardener","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James F","family":"Benenati","sequence":"additional","affiliation":[{"name":"Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nirvikar","family":"Dahiya","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mayo Clinic, Phoenix, AZ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi M","family":"Hamburg","sequence":"additional","affiliation":[{"name":"Whitaker Cardiovascular Institute, Boston University, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann Marie","family":"Kupinski","sequence":"additional","affiliation":[{"name":"Albany Medical College, Albany, NY, USA"},{"name":"North Country Vascular Diagnostics, Inc., Altamont, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven A","family":"Leers","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P","family":"Lilly","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Maryland School of Medicine, Baltimore, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joann M","family":"Lohr","sequence":"additional","affiliation":[{"name":"Department of Surgery, Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John S","family":"Pellerito","sequence":"additional","affiliation":[{"name":"Department of Radiology, Northwell Health and Zucker School of Medicine at Hofstra\/Northwell, Manhasset, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth S","family":"Rholl","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Interventional Radiology, Inova Alexandria Hospital, George Washington University, Alexandria, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa A","family":"Vickery","sequence":"additional","affiliation":[{"name":"VSA Vascular Lab, Vascular Surgery Associates, Richmond, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marge S","family":"Hutchisson","sequence":"additional","affiliation":[{"name":"Intersocietal Accreditation Commission (IAC), Vascular Testing Division, Ellicott City, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence","family":"Needleman","sequence":"additional","affiliation":[{"name":"Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,5,19]]},"reference":[{"key":"bibr1-1358863X211011253","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31820d8d78"},{"key":"bibr2-1358863X211011253","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.64.6.1191"},{"key":"bibr3-1358863X211011253","doi-asserted-by":"publisher","DOI":"10.1002\/jcu.1870150906"},{"key":"bibr4-1358863X211011253","doi-asserted-by":"publisher","DOI":"10.1016\/0741-5214(93)90019-I"},{"key":"bibr5-1358863X211011253","doi-asserted-by":"publisher","DOI":"10.1148\/radiographics.8.3.3289100"},{"key":"bibr6-1358863X211011253","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2292030516"},{"key":"bibr7-1358863X211011253","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2008.10.015"},{"key":"bibr8-1358863X211011253","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.636084"},{"key":"bibr9-1358863X211011253","first-page":"373","volume":"1","author":"Roederer GO","year":"1982","journal-title":"J Cardiovasc Ultrasonography"},{"key":"bibr10-1358863X211011253","first-page":"174","volume":"8","author":"Roederer GO","year":"1984","journal-title":"Bruit"},{"key":"bibr11-1358863X211011253","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.22.6.816"},{"key":"bibr12-1358863X211011253","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.043963"},{"key":"bibr13-1358863X211011253","unstructured":"IAC Vascular Testing White Paper on Carotid Stenosis Interpretation Criteria, https:\/\/www.intersocietal.org\/vascular\/forms\/iaccarotidcriteriawhitepaper1-2014.pdf (2014, accessed 18 April 2020)."},{"key":"bibr14-1358863X211011253","doi-asserted-by":"publisher","DOI":"10.1016\/S0741-5214(96)70269-0"},{"key":"bibr15-1358863X211011253","doi-asserted-by":"publisher","DOI":"10.4065\/75.11.1133"},{"key":"bibr16-1358863X211011253","unstructured":"2019 IAC Standards and Guidelines for Vascular Testing Accreditation, https:\/\/www.intersocietal.org\/vascular\/seeking\/vascular_standards.htm (2019, accessed 18 April 2020)."},{"key":"bibr17-1358863X211011253","doi-asserted-by":"publisher","DOI":"10.1159\/000343145"},{"key":"bibr18-1358863X211011253","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.22.6.711"},{"key":"bibr19-1358863X211011253","unstructured":"2019 MIPS Clinical Quality Measures (CQMS). MIPS Measure #195. Radiology: Stenosis measurement in carotid imaging reports, https:\/\/qpp.cms.gov\/docs\/QPP_quality_measure_specifications\/CQM-Measures\/2019_Measure_195_MIPSCQM.pdf (2019, accessed 17 January 2021)."},{"key":"bibr20-1358863X211011253","doi-asserted-by":"publisher","DOI":"10.1097\/00004424-197903000-00002"},{"key":"bibr21-1358863X211011253","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2010.07.045"},{"key":"bibr22-1358863X211011253","doi-asserted-by":"publisher","DOI":"10.1177\/1538574412452159"},{"key":"bibr23-1358863X211011253","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2018.10.054"},{"key":"bibr24-1358863X211011253","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.14.6.885"},{"key":"bibr25-1358863X211011253","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.25.12.2435"},{"key":"bibr26-1358863X211011253","doi-asserted-by":"publisher","DOI":"10.1161\/circ.124.suppl_21.A8918"}],"container-title":["Vascular Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1358863X211011253","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1358863X211011253","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1358863X211011253","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T03:31:55Z","timestamp":1777692715000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1358863X211011253"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,19]]},"references-count":26,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021,10]]}},"alternative-id":["10.1177\/1358863X211011253"],"URL":"https:\/\/doi.org\/10.1177\/1358863x211011253","relation":{},"ISSN":["1358-863X","1477-0377"],"issn-type":[{"value":"1358-863X","type":"print"},{"value":"1477-0377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,19]]}}}