Doppler Ultrasonography and Computed Tomography Angiography in Carotid Artery Stenosis

OBJECTIVES: The degree of carotid artery stenosis influences surgical decision-making; therefore, accurate assessment is essential for appropriate patient selection. This study evaluated agreement between Doppler ultrasonography (DUS) and computed tomography angiography (CTA) in patients with significant stenosis detected on DUS and investigated factors associated with discordance. METHODS: In this retrospective study, 79 patients who underwent DUS between January 2024 and October 2025 were included. DUS stenosis grade, CTA stenosis according to NASCET and ECST methods, lumen diameters, plaque characteristics, and accompanying vascular features were evaluated. RESULTS: Agreement between DUS and CTA was fair using NASCET (κ = 0.413; p < .001) and moderate using ECST (κ = 0.531; p < .001). Agreement between NASCET and ECST was substantial (κ = 0.799; p < .001). Discordance was most frequent in the 50-69% DUS stenosis group and varied according to stenosis severity and CTA measurement method. Plaque type, plaque length, and calcification were not associated with discordance. Residual lumen diameter on CTA was significantly larger in NASCET-based discordant cases (p = .018) whereas no significant difference was observed using ECST classification. In some patients, discrepancies could potentially affect surgical decision-making. CONCLUSION: Agreement between DUS and CTA in significant carotid stenosis was fair using NASCET and moderate using ECST, with discordance particularly frequent in the 50-69% stenosis group and dependent on the CTA measurement method. Combined assessment with 2 noninvasive imaging modalities may help reduce misclassification in patients considered for surgical treatment.