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Atherosclerosis in primary antiphospholipid syndrome
  1. P R J Ames1,
  2. K Sokoll1,
  3. M Weston2,
  4. A Margarita3,
  5. V Brancaccio3
  1. 1Academic Department of Rheumatology, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
  2. 2Department of Radiology, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK
  3. 3Angiology and Coagulation Units, Cardarelli Hospital, Via A Cardarelli, 80100 Naples, Italy
  1. Correspondence to:
    Dr P R J Ames

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We read with great interest the article by Medina et al about atherosclerosis in primary antiphospholipid syndrome (APS).1 They showed that the intima-media thickness (IMT) of carotid arteries from patients with primary APS was greater than that of age and sex matched controls.

We wish to comment on their methodology and findings. For the ultrasound technique Medina et al did not define the area where the measurement of IMT was taken, nor did they specify whether the anterior or posterior carotid wall was measured. The anterior or near wall is prone to reverberation artefact, making placement of the callipers difficult. IMT should be measured at a site away from atheromatous plaques. The figures provided by Medina et al show that colour and power Doppler were used to define the lumen of the vessel, but there is no mention of how these were standardised. The gain, pulse repetition frequency, prioritisation of colour versus grey scale, use of contrast agents, angle of insonation, and the velocity of blood flow (systole or diastole) will all affect the …

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