{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T10:58:37Z","timestamp":1775818717285,"version":"3.50.1"},"reference-count":23,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Carotid artery stenosis has traditionally guided therapeutic decision-making; however, plaque morphology and composition are increasingly recognized as more reliable indicators of cerebrovascular risk than luminal narrowing alone. As imaging strategies shift toward vulnerability-based assessment, reproducibility of plaque characterization becomes essential for consistent clinical decision-making. This study aimed to evaluate interobserver agreement in carotid plaque assessment using multidetector computed tomography angiography (MDCTA) and to assess intermodality agreement with duplex ultrasonography (DUS). Materials and Methods: In this single-center study (January\u2013September 2022), 50 patients with \u226560% internal carotid artery stenosis diagnosed by DUS (NASCET criteria), the majority of whom were asymptomatic (90%), were included. MDCTA examinations were independently analyzed by two radiologists, while DUS examinations were evaluated by a third observer. Plaque composition (lipid, fibrous, calcified), surface characteristics (regular, irregular, ulcerated), degree of stenosis, and plaque length were assessed. CT plaque characterization was based on Hounsfield unit (HU) thresholds (&lt;50 HU lipid; 50\u2013120 HU fibrous; &gt;120 HU calcified). Interobserver agreement and intermodality agreement were calculated using Cohen\u2019s kappa coefficient. Results: Good interobserver agreement was observed between the two MDCTA readers (\u03ba = 0.751). Intermodality agreement between MDCTA and DUS was moderate (\u03ba = 0.624 and \u03ba = 0.595). Although significant differences were identified in 3 of 16 HU measurement points, no significant differences were found in overall plaque composition classification between MDCTA observers. DUS yielded significantly higher stenosis values (p = 0.007 and p = 0.005) and greater plaque length measurements (p &lt; 0.0005) compared with MDCTA. Significant differences were also observed in plaque surface assessment between modalities (p = 0.044 and p = 0.033). Conclusions: MDCTA demonstrates good interobserver reproducibility for carotid plaque characterization, while intermodality agreement between MDCTA and DUS is moderate. Minor attenuation measurement differences do not significantly affect plaque classification; however, systematic intermodality differences in stenosis grading, plaque surface evaluation, and plaque length measurement should be considered in clinical decision-making.<\/jats:p>","DOI":"10.3390\/medicina62040724","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T09:08:12Z","timestamp":1775812092000},"page":"724","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Carotid Plaque Characteristics Evaluation on DUS and MDCTA: Interobserver and Intermodality Agreement in a Single-Center Study"],"prefix":"10.3390","volume":"62","author":[{"given":"Perica","family":"Mutavdzic","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tijana","family":"Kokovic","sequence":"additional","affiliation":[{"name":"Center for Radiology, University Clinical Center of Vojvodina, 21000 Novi Sad, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Branko","family":"Gakovic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8129-9878","authenticated-orcid":false,"given":"David","family":"Matejevi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivan","family":"Tomi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milo\u0161","family":"Sladojevi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aleksandar","family":"Tomic","sequence":"additional","affiliation":[{"name":"Medical Faculty, Military Medical Academy, Belgrade Defence University, 11040 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Igor","family":"Koncar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"European Carotid Surgery Trialists\u2019 Collaborative Group (1998). 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