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KMID : 1150320220180020038
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Journal of Korean Society of Geriatric Neurosurgery
2022 Volume.18 No. 2 p.38 ~ p.43
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Classification of carotid plaque vulnerability by neurosurgical residents using ultrasonography in the clinical field
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Na Do-Young
Kim Jun-Mo
Chung Kyung-Min
Han Seung-Hun
Yun Gi-Hyeok
Yang Jin-Seo
Choi Hyuk-Jai
Kim Heung-Cheol
Cho Yong-Jun
Jeon Jin-Pyeong
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Abstract
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Objective: We aimed to evaluate the accuracy of the classification of carotid plaque vulnerability (unstable vs. stable plaques) by neurosurgical residents based on carotid ultrasonography (US) images.
Methods: A total of 405 subjects with 995 images were included in the study. Using a neuroradiologist’s decision as the reference value, the classification results of five reviewers were analyzed. The sensitivity, specificity, and overall accuracy were estimated. Then, a pairwise comparison of the receiver operating characteristic (ROC) curve and precision-recall curve was performed to compare the reviewers’ classification accuracy.
Results: The mean age of the subjects was 70.5 years (range, 44-91 years) and 223 (55.1%) were female. The number of unstable and stable plaques was 236 (24.7%) and 749 (75.3%), respectively. The best-balanced classification performance of plaque vulnerability was a sensitivity of 83.7% (95% confidence interval [CI], 78.5%-88.1%), specificity of 69.0% (95% CI, 65.6%-72.3%), and overall accuracy of 72.7% (95% CI, 69.8%-75.4%). The best ROC performance was an area under the curve (AUC) of 0.583 (95% CI, 0.552-0.614). The precision-recall curve also showed low classification accuracy among the reviewers (AUC difference: 0.028; 95% bootstrap CI, 0.007-0.048).
Conclusion: The classification accuracy of neurosurgical residents to discriminate plaque vulnerability seen on carotid US images was low in a real-world clinical setting. Thus, it is necessary to develop systems that help to educate and automatically interpret plaque stability.
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KEYWORD
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Carotid artery plaque, Ultrasonography, Carotid arteries
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