Combined Use of Color Duplex Ultrasonography and B-flow Imaging for Evaluation of Patients with Carotid Artery Stenosis AJNR Am J Neuroradiol 25: 1856-1860,

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Presentation transcript:

Combined Use of Color Duplex Ultrasonography and B-flow Imaging for Evaluation of Patients with Carotid Artery Stenosis AJNR Am J Neuroradiol 25: 1856-1860, November/December 2004 Intern 潘師典

Introduction of carotid artery stenosis High-grade ICA stenosis: increased risk for TIA, stroke, carotid occlusion, embolism arising from thrombi forming at site of narrowing Plaque forms in a blood vessel when cholesterol, fat and other substances build up in the inner lining of an artery. This process is called atherosclerosis

Stenosis measurement Identify NASCET: 70~99% ICAS

How to evaluate Noninvasive: Color duplex ultrasonography (CDU) B-flow imaging (BFI) MRA CTA Invasive: Digital subtraction angiography (DSA)

Methods 1/2 67 men and 28 women with mean age of 66 yrs (age range, 46-85 yrs) Be excluded: (29) 147 1. previous ipsilateral carotid endarterectomy 2. high bifurcation of CCA, or a short neck (6) 3. no role in duplex velocity measurement, such as occlusion (10) or string sign (2) 4. calcification extensive enough to obscure sonography single intensity in the stenotic area (11)

Methods 2/2 All CDU and BFI were performed by the same radiologists, who were unaware of each other’s test results, at the same day. The radiologist who assessed the angiograms was blinded for the results of ultrasonography examination. The results of CDU and BFI were first analyzed seperately and compared with standard DSA.

GE Logiq 700 with a 5- to 10- MHz linear array transducer ICA ECA CDU 60o Dynamic range: 60dB Gain: 50% Transverse and Longitudinal planes CCA BFI

DSA Performed with a Polytron V 1000 angiographic unit by using a Seldinger technique Each projection, 8mL of contrast medium, with a flow rate of 4mL/s

Result 33 (17%)

What’s different between CDU and BFI ?

Limitation CDU: BFI: CCA diameter variation and Variable collateral flow Extensive calcification Backgroung flash Slow flow… Duplex velocity measurement arrhythmia, valve insuffucincy, Tandem plaques AVM, carotid body tumor, Carotid a. coiling or kinking, Severe contralateral stenosis Real-time hemodynamic flow Excessive pulsation of vessel leads to movement of surrounding tissues (vessel wall: ill-defined)

Conclusion In the diagnosis of CAS: 1. Slightly better accuracy  CDU > BFI 2. combined use > alone 3. DSA> combined use