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Saudi Journal of Radiology

Volume 3, 2024 · Issue Proceeding of the 15th Annual Meeting of Radiology Society of Saudi Arabia (RSSA) · Open Access · Double-blind Peer-review

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Original Research Article

Assessment of Inter-Observer Variability, Cardiac Cycle and Gender Influence on Carotid Intima-Media Thickness Measured Using Ultrasound in Healthy Adults

Abrar Alfatni1

1 King Abdulaziz University

Published: 11 May 2026

https://doi.org/10.55038/fv5jqb53
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Abstract
Background : Carotid intema-media thickness (cIMT) is a widely utilized noninvasive marker for assessing early atheroscelorosis and cardiovascular risk. cIMT is commonly measured using B-mode ultrasound; however, several factors can introduce variability, including the cardiac cycle phase (systole vs. diastole) and interobserver differences. This study aims to evaluate the inter-observer variability in cIMT measurements and to determine differences in cIMT across genders, cardiac cycle phases, and contralateral carotid arteries. Methods: cIMT measurements were obtained using B-mode ultrasound from 50 healthy adults (25 males, 25 females) bilaterally during both systolic and diastolic phases. Two independent operators performed the measurements to assess inter-observer variability using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. Gender differences, cardiac cycle phase effects, and differences between contralateral sides were analyzed using paired t-tests. Results: A total of 200 cIMT measurements were analyzed. Inter-observer agreement was moderate (ICC = 0.68) with a small bias (-0.02 ± 0.05 mm). Males exhibited significantly higher cIMT than females (mean difference = 0.08 mm, 95% CI 0.07–0.10, p < 0.001). No significant differences were found in cIMT between systolic and diastolic phases (p = 0.51) or between right and left carotid arteries (p = 0.70). Conclusion: The study demonstrates moderate inter-observer variability in cIMT measurements using B-mode ultrasound. Gender significantly influences cIMT, with males having thicker cIMT compared to females. However, no significant differences were observed between cardiac cycle phases or between contralateral sides of the carotid arteries.
KeywordsCarotid intima-media thicknessB-mode ultrasoundatherosclerosis

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References

  1. [1] Willeit P, Tschiderer L, Allara E. Carotid intima-media thickness pro-
  2. gression as surrogate marker for cardiovascular risk: Meta-analysis of 119
  3. clinical trials involving 100,667 patients. Circulation. 2020;142:621–642.
  4. doi:https://doi.org/10.1161/CIRCULATIONAHA.120.046361.
  5. [2] Kasliwal RR, Bansal M, Desai D, Sharma M. Carotid intima-media thickness: Current
  6. evidence, practices, and Indian experience. Indian J Endocrinol Metab. 2014;18:13–
  7. 22. doi:https://doi.org/10.4103/2230-8210.126522.
  8. [3] Gonzalez J, Wood JC, Dorey FJ. thickness measurements in young adults. doi:https://doi.org/10.1148/radiol.2472070691.
  9. Reproducibility of carotid intima-media
  10. Radiology. 2008;247:465–471.
  11. [4] Menees S, Zhang D, Le J. during the cardiac cycle in children. doi:https://doi.org/10.1016/j.echo.2009.10.016.
  12. Variations in carotid artery intima-media thickness
  13. J Am Soc Echocardiogr. 2010;23:58–63.
  14. [5] Kanters SD, Algra A, Van Leeuwen MS, Banga JD. Reproducibility of in vivo
  15. carotid intima-media thickness measurements: a review. Stroke. 1997;28:665–671.
  16. doi:https://doi.org/10.1161/01.str.28.3.665.
  17. [6] George JM, Bhat R, Pai KM. dictor of the Clincal Coronary Events. doi:https://doi.org/10.7860/JCDR/2013/4767.3029.
  18. The Carotid Intima Media Thickness: A Pre-
  19. J Clin Diagn Res. 2013;7:1082–1085.
  20. [7] Sharma K, Blaha MJ, Blumenthal RS, Musunuru K. cations of carotid intima-media thickness. doi:https://doi.org/10.1016/j.amjcard.2009.01.020.
  21. Clinical and research appli-
  22. Am J Cardiol. 2009;103:1316–1320.
  23. [8] Bauer M, Caviezel S, Teynor A. biomarker of subclinical atherosclerosis. doi:https://doi.org/10.4414/smw.2012.13705.
  24. Carotid intima-media thickness as a
  25. Swiss Med Wkly. 2012;142:13705–13705.
  26. [9] Alghamdi R, Zabani R, Alahmari T et al.. Variability of Common Carotid Intima-
  27. media Thickness Measured using B-mode and M-mode Ultrasound Imaging; 2023.
  28. [10] Qu B, Qu T. 015-0041-4.
  29. Causes of changes in carotid intima-media thickness: a literature
  30. review. Cardiovasc Ultrasound. 2015;13:46–46. doi:https://doi.org/10.1186/s12947- [11] Abeysuriya V, Perera B, Wickremasinghe AR. Regional and demo-
  31. graphic variations of Carotid artery Intima and Media Thickness (CIMT): A Systematic review and meta-analysis. doi:https://doi.org/10.1371/journal.pone.0268716.
  32. PLoS One. 2022;17:e0268716. [12] Koo TK, Li MY. Guideline of Selecting and Reporting Intraclass Correla-
  33. tion Coefficients for Reliability Research. J Chiropr Med. 2016;15:155–163.
  34. doi:https://doi.org/10.1016/j.jcm.2016.02.012.
  35. [13] Popović ZB, Thomas JD. Assessing observer variability: a user’s guide. Cardiovascu-
  36. lar Diagnosis and Therapy. 2017;7. doi:https://doi.org/10.21037/cdt.2017.03.12.
  37. [14] Giavarina D. Understanding Bland Altman analysis. Biochem Med (Zagreb).
  38. 2015;25:141–151. doi:https://doi.org/10.11613/BM.2015.015.
  39. [15] Hagiwara A, Fujita S, Ohno Y, Aoki S. ization of Quantitative Imaging. doi:https://doi.org/10.1097/RLI.0000000000000666.
  40. Variability and Standard-
  41. Invest Radiol. 2020;55:601–616.
  42. [16] Salonen R, Haapanen A, Salonen JT. Measurement of intima-media thick-
  43. ness of common carotid arteries with high-resolution B-mode ultrasonography:
  44. inter- and intra-observer variability. Ultrasound Med Biol. 1991;17:225–230.
  45. doi:https://doi.org/10.1016/0301-5629(91)90043-v.
  46. [17] Łoboz-Rudnicka M, Jaroch J, Bociąga Z. Impact of cardiovascular risk factors on
  47. carotid intima-media thickness: sex differences. Clin Interv Aging. 2016;11:721–731.
  48. doi:https://doi.org/10.2147/CIA.S103521.
  49. [18] Wu TW, Hung CL, Liu CC. Associations of Cardiovascular Risk Factors with Carotid
  50. Intima-Media Thickness in Middle-Age Adults and Elders. J Atheroscler Thromb.
  51. 2017;24:677–686.
  52. [19] Tan TY, Lu CH, Lin TK, Liou CW, Chuang YC, Schminke U. Fac-
  53. tors associated with gender difference in the intima–media thickness of
  54. the common carotid artery. Clinical Radiology. 2009;64(11):1097–1103.
  55. doi:https://dx.doi.org/10.1016/j.crad.2009.06.009.
  56. [20] Mazurek K, Zmijewski P, Czajkowska A, Lutosławska G. Gender differences in
  57. carotid artery intima-media thickness and flow-mediated dilatation in young, phys-
  58. ically active adults. J Sports Med Phys Fitness. 2014;54:298–306.
  59. [21] Polak JF, Johnson C, Harrington A. Changes in Carotid Intima-Media Thickness
  60. During the Cardiac Cycle: The Multi-Ethnic Study of Atherosclerosis. J Am Heart
  61. Assoc. 2012;1(001420). [22] Rueb K, Mynard J, Liu R, Wake M, Vuillermin P, Ponsonby AL et al. Changes
  62. in carotid artery intima-media thickness during the cardiac cycle – a comparative
  63. study in early childhood, mid-childhood, and adulthood. Vasa. 2017;46(4):275–281.
  64. doi:https://dx.doi.org/10.1024/0301-1526/a000630.
  65. [23] Chiesa ST, Charakida M, Georgiopoulos G, Dangardt F, Wade KH, Rapala A et al.
  66. Determinants of Intima-Media Thickness in the Young. JACC: Cardiovascular Imag-
  67. ing. 2021;14(2):468–478. doi:https://dx.doi.org/10.1016/j.jcmg.2019.08.026.
  68. [24] Kresnajati S, Lin YY, Mündel T, Bernard JR, Lin HF, Liao YH. Changes in Arterial
  69. Stiffness in Response to Various Types of Exercise Modalities: A Narrative Review
  70. on Physiological and Endothelial Senescence Perspectives. Cells. 2022;11(22):3544–
  71. 3544. doi:https://dx.doi.org/10.3390/cells11223544.
  72. [25] Panprasit W, u-dom Silkosessak OC, Mukdeeprom P, Charoenlarp P.
  73. Sonographic assessment of carotid intima-media thickness in healthy
  74. young Thai adults. Imaging Science in Dentistry. 2023;53(4):291–291.
  75. doi:https://dx.doi.org/10.5624/isd.20230021.
  76. [26] Luo X, Yang Y, Cao T, Li Z. thickness and the associated risk factors. doi:https://dx.doi.org/10.1016/j.crad.2010.12.002.
  77. Differences in left and right carotid intima–media
  78. Clinical Radiolo