Table 14. Outcomes of diagnostic testing for carotid stenosis in 1000 hypothetical patients with stroke: effect of varying prevalence

Description of Testing Strategies:
Description of Testing Strategies:

"CUS or MRA alone" assumes patients undergo CUS or MRA, undergo CEA if test is positive, and are managed non-surgically if test is negative.

"Angiogram if positive" assumes patients undergo CUS or MRA, undergo cerebral angiography if non-invasive test is positive, and are managed non-surgically if non-invasive test is negative; those undergoing angiography are assumed to undergo CEA if angiography is positive.

"CUS+MRA, angiogram if not concordant" assumes patients undergo both CUS and MRA, undergo CEA if both tests are positive, are managed non-surgically if both tests are negative, and undergo cerebral angiography if one test is positive and the other negative; those undergoing angiography are assumed to undergo CEA if angiography is positive.
 Undergo
Angiography		Undergo CEA
Inappropriately		 
 Undergo
Angiography		Undergo CEA
Inappropriately		 
Prevalence of stenosis > 70% = 10%
Test Characteristic Assumptions
 SensitivitySpecificity
CUS:0.9440.840
MRA:0.9180.965
CUS+MRA:0.9510.984
CUS alone 0144
MRA alone 032
CUS, angiogram if positive 2380
MRA, angiogram if positive 1230
CUS+MRA, angiogram if not concordant 18212
Prevalence of stenosis > 70% = 30%
CUS alone 0112
MRA alone 025
CUS, angiogram if positive 3950
MRA, angiogram if positive 3000
CUS+MRA, angiogram if not concordant 1829
Prevalence of stenosis > 70% = 50%
CUS alone 080
MRA alone 018
CUS, angiogram if positive 5520
MRA, angiogram if positive 4770
CUS+MRA, angiogram if not concordant 1827

From: 4, Results - Carotid Imaging

Cover of Effectiveness and Cost-Effectiveness of Echocardiography and Carotid Imaging in the Management of Stroke
Effectiveness and Cost-Effectiveness of Echocardiography and Carotid Imaging in the Management of Stroke.
Evidence Reports/Technology Assessments, No. 49.
Meenan RT, Saha S, Chou R, et al.
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