Learning objectives
Our purpose is to discuss the use of contrast-enhanced ultrasound (CEUS) in major cervical vessels,
namely the carotid arteries and internal jugular veins.
Educational images will be presented correlating and comparing the findings of unenhanced ultrasound and carotid Multidetector Computed Tomography Angiography (MDCTA) or Magnetic Resonance Angiography (MRA) with CEUS findings,
in an attempt to illustrate the added value of CEUS.
Pathologies presented include:
Carotid atherosclerotic disease with the following aspects:
a.Ulcerated carotid plaques
b.Near-occlusion,
falsely characterized as occlusion on US
c.Carotid occlusion
d.Symptomatic carotid...
Background
Ultrasound with colour Doppler imaging (CDI) represents the first-line modality for evaluation of both carotid arteries pathology and internal jugular vein thrombosis,
although characterized by inherent limitations associated with technical artifacts.
These artifacts include Doppler angle dependency,
overwriting artifact and aliasing.
Doppler angle dependency constitutes a significant limitation as it may be lead to suboptimal visualization of blood flow.
As a consequence,
segments of the vascular lumen with slow flow or with inadequate Doppler angle may appear void of flow,
in keeping with occlusion,
although...
Findings and procedure details
CEUS should always follow an unenhanced ultrasound examination.
It was performed using a 5-10 MHz linear probe and a low-MI technique (MI approximately 0.09-0.2) on a modern ultrasound device capable of CEUS.
The contrast-enhanced part of the examination was performed after 2.4 ml of SonoVue© were administered intravenously via a 20-gauge cannula placed in the antecubital fossa and flushed with 5-10 ml of normal saline.
A second dose of 2.4 ml was administered if considered necessary (for example for the evaluation of the contralateral carotid...
Conclusion
CEUS is a valuable complementary ultrasonographic technique for evaluation of cervical vessels,
helping to overcome some of the unenhanced technique’s inherent limitations and providing clinically significant information.
It is our belief that CEUS has important inherent advantages and may benefit the patients if incorporated as a complementary ultrasonographic technique in diagnostic strategies,
especially in patients with impaired renal function.
Nevertheless,
by no means should it be regarded as a modality capable of completely replacing MDCTA or MRA in the evaluation of the carotid arteries or...
Personal information
Vasileios Rafailidis MD MSc:Department of Radiology,
AHEPA University General Hospital of Thessaloniki,
Aristotle University of Thessaloniki,
Greece
Email:
[email protected]
Ioannis Chryssogonidis Asst Prof:Department of Radiology,
AHEPA University General Hospital of Thessaloniki,
Aristotle University of Thessaloniki,
Greece
Thomas Tegos Asst Prof:1st Neurological Department,
AHEPA University General Hospital,
Aristotle University of Thessaloniki,
Thessaloniki,
Greece
Irini Nikolaou MD:Department of Radiology,
AHEPA University General Hospital of Thessaloniki,
Aristotle University of Thessaloniki,
Greece
Constantinos Kouskouras Asst Prof:Department of Radiology,
AHEPA University General Hospital of Thessaloniki,
Aristotle University of Thessaloniki,
Greece...
References
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