From the Guidelines
Diagnostic Criteria for Cervical Stenosis
The diagnostic criteria for cervical stenosis are primarily based on the severity of stenosis, which is defined according to angiographic criteria by the method used in NASCET 1.
- Key diagnostic methods include:
- Carotid ultrasonography
- Computed Tomography Angiography (CTA)
- Magnetic Resonance Angiography (MRA)
- Severity of stenosis is crucial for selecting appropriate patients for surgical or endovascular intervention, with 75% diameter stenosis corresponding to >90% reduction in the cross-sectional area of the lumen 1.
- Catheter-based angiography may be necessary in some cases for definitive diagnosis or to resolve discordance between noninvasive imaging findings 1.
- Indications for carotid duplex sonography include cervical bruit in asymptomatic patients, follow-up of known stenosis, vascular assessment in patients with multiple risk factors for atherosclerosis, and stroke risk assessment in patients with coronary or peripheral artery disease 1.
- CTA has compared favorably with catheter angiography for evaluation of patients with extracranial carotid and vertebral artery disease, with high sensitivity and specificity for detecting 70% carotid artery stenosis 1.
- Limitations of these diagnostic methods include the potential for overestimation of stenosis severity, difficulties in assessing heavily calcified lesions, and restrictions due to renal function or the presence of metallic implants 1.
From the Research
Diagnostic Criteria for Cervical Stenosis
The diagnostic criteria for cervical stenosis are not explicitly stated in the provided studies. However, the studies suggest that cervical stenosis can be diagnosed based on the presence of certain symptoms and findings, including:
- Difficulty or inability to cannulate the endocervical canal during procedures such as hysteroscopy, dilation and curettage, or embryo transfer 2, 3
- History of cervical procedures, such as cone biopsy, which can increase the risk of cervical stenosis 3
- Postmenopausal status, which can increase the risk of cervical stenosis 3
- Symptoms such as amenorrhea, cyclical pain, infertility, and haematometra 4
Key Findings
Some key findings that may indicate cervical stenosis include:
- Inability to visualize the external cervical os during hysteroscopy 3
- Difficulty or inability to enter the uterine cavity during hysteroscopy or other procedures 2, 3
- Presence of a stenotic or obliterated external cervical os 3
- History of failed attempts to cannulate the endocervical canal or perform procedures such as hysteroscopy or embryo transfer 2, 5
Diagnostic Techniques
Various diagnostic techniques can be used to evaluate cervical stenosis, including:
- Hysteroscopy, which can be used to visualize the uterine cavity and diagnose cervical stenosis 2, 3
- Ultrasound guidance, which can be used to identify the location of the external cervical os and guide cannulation of the endocervical canal 4
- Fluoroscopic guidance, which can be used to guide cervical dilatation and cannulation of the endocervical canal 5