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John E. Castaldo, MD; Gary G. Nicholas, MD; William Gee, MD; James F. Reed, PhD

Arch Neurol. 1989;46(5):518-522.

Abstract
• Concordance between two independent tests should serve to increase the accuracy of diagnosis. A combination of ocular pneumoplethysmography and duplex ultrasound, which uses high-resolution B-mode imaging plus spectral analysis, was used to evaluate 289 consecutive patients prior to biplane carotid angiography. Where there was concordance, the noninvasive tests predicted the presence or absence of hemodynamically severe carotid stenosis (75% or greater crosssectional area reduction) with a sensitivity of 96.8%, a specificity of 95.9%, an accuracy of 96.2%, and positive and negative predictive values of 91.0% and 98.6%, respectively. Of the 538 study arteries, only four (0.74%) angiographically severe lesions escaped detection by both noninvasive tests. Sources of diagnostic error for both tests were defined. We believe that the combination of duplex ultrasound and ocular pneumoplethysmography significantly improves the overall assessment of carotid atherosclerosis.

Author Affiliations
From the Division of Neurology (Dr Castaldo), the Department of Surgery (Dr Nicholas), the Vascular Laboratory (Dr Gee), and the Research Department (Dr Reed), The Allentown (Pa) Hospital—Lehigh Valley Hospital Center.

Footnotes
Accepted for publication September 3, 1988.

Reprint requests to the Division of Neurology, The Allentown Hospital—Lehigh Valley Hospital Center, 1200 S Cedar Crest Blvd, Allentown, PA 18103 (Dr Castaldo).

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