Carotid stenosis evaluation by 64-slice CTA: comparison of NASCET, ECST and CC grading methods

Purpose is to evaluate the intraobserver and interobserver variability of the North American Symptomatic Carotid Endarterectomy Trial (NASCET), European Carotid Surgery Trial (ECST) and Common Carotid (CC) methods, which are used to measure the degree of ICA stenosis, using 64-slice CT angiography and to compare the measurements made by these three methods. 88 cases (111 carotid arteries) were included in the study. Carotid CTA was performed by a 64 slice scanner (Toshiba, Aqullion 64).Two radiologists measured the degree of carotid stenosis by using NASCET, ECST and CC methods. Intraobserver and interobserver variability of each method was determined by intraclass correlation coefficient (ICC), Bland–Altman plots and kappa and linear weighted kappa statistics. The relation between the measurements was assessed by correlation coefficient (with linear and quadratic methods). Correlation coefficients showed that there is linear correlation between the measurements made by the three methods. The degree of stenosis measured with the NASCET method had the lowest value, while the corresponding values measured with the ECST and CC methods were close to each other. ICC and Bland–Altman plots showed high intra and inter observer agreement for NASCET, ECST and CC methods whereas kappa statistics showed moderate to substantial agreement. CC method had slightly higher agreement when compared with the other two methods. Intra and interobserver agreement is high for NASCET, ECST and CC methods however CC method has a slightly higher reproducibility. There is linear correlation between the measurements made by the three methods.