Authors’ Response to Letter: Validation of Multiparametric Ultrasonography Criteria with Digital Subtraction Angiography in Carotid Artery Disease: A Prospective Multicenter Study

We thank Prof. von Reutern for commenting on our article on the prospective multicenter validation of the revised DEGUM ultrasound criteria for carotid artery stenosis grading [1] [2]. We would like to emphasize that our study was not meant to evaluate the ultrasound modality per se, but rather the revised and widely used multiparametric DEGUM approach for ultrasound grading of carotid artery disease as many other approaches have been validated before [3]. Any diagnostic approach adopted by an ultrasound laboratory has to undergo validation [4], especially when it is regularly used for treatment decisions in carotid artery disease. We agree that technological progress in the last decades and improved understanding of hemodynamics have facilitated the assessment of carotid artery disease. However, this alone does not supersede its scientific validation.

• References

• 1 Barlinn K, Rickmann H, Kitzler H. et al. Validation of Multiparametric Ultrasonography Criteria with Digital Subtraction Angiography in Carotid Artery Disease: A Prospective Multicenter Study. Ultraschall Med 2018; 39: 535-543
• 2 Arning C, Widder B, von Reutern GM. et al. Ultraschallkriterien zur Graduierung von Stenosen der A. carotis interna – Revision der DEGUM-Kriterien und Transfer in NASCET-Stenosierungsgrade. Ultraschall in Med 2010; 31: 251-257
• 3 Wardlaw JM, Chappell FM, Best JJ. et al. Non-invasive imaging compared with intra-arterial angiography in the diagnosis of symptomatic carotid stenosis: a metaanalysis. Lancet 2006; 367: 1503-1512
• 4 Intersocietal Accreditation Commission. https://www.intersocietal.org/vascular/standards/IACVascularTestingStandards2018.pdf Accessed March 06 2019
• 5 Grant EG, Benson CB, Moneta GL. et al. Carotid artery stenosis: gray-scale and Doppler US diagnosis–Society of Radiologists in Ultrasound Consensus Conference. Radiology 2003; 229: 340-346
• 6 Winzer S, Puetz V, Kitzler HH. et al. Ultrasonography Grading of Internal Carotid Artery Disease: Multi-Parametric DEGUM versus SRU Consensus Criteria. Stroke 2017; 48: ATMP32