Evaluation of Carotid Artery Plaques with B-Flow Sonography and Comparing the Results with Color, Power Doppler US and DSA

Yıl 2021, Cilt: 2 Sayı: 1, 50 - 57, 25.01.2021

Terman Gümüş Cem Yücel Suna Oktar Hakan Özdemir Baran Önal Erhan Turgut Ilgıt

Öz

PURPOSE: To evaluate carotid artery lesions with B-flow sonography and compare the findings with color, power Doppler sonography and digital subtraction angiography (DSA).

MATERIALS AND METHODS: Forty-Three patients (30 male, 14 female; mean age 64±9.2; age range: 42-81) with 61 carotid artery lesions were involved in the study. The lesions were evaluated with color, power Doppler and B-flow sonography. All images were reviewed and graded independently by two radiologists for surface delineation, plaque morphology and overall image quality. The grades for each technique were compared with Friedman and Wilcoxon tests. Simple regression analysis was used to compare the percentage of stenosis calculated with different sonographic techniques and DSA for lesions causing more than 60 % stenosis.

RESULTS: Statistical analysis with Friedman test revealed that B-flow is superior to other sonographic techniques for all three parameters (plaque surface delineation, plaque morphology and overall image quality). Wilcoxon test also showed B-flow is superior to other methods for the evaluation of plaque surface delineation and plaque morphology (p=0.000); while no significant difference was found between B-flow and power Doppler imaging for the evaluation of overall image quality (p=0.09). Kappa scores reflected moderate to good interobserver correlation (0.297-0.659). The percentage of stenosis calculated with both B-flow and power Doppler sonography correlated with DSA significantly (p=0.000).

CONCLUSION: B-flow sonography is a technique that provides direct visualization of the blood echoes and the morphology of the surrounding vessel wall simultaneously. This technique maintains more efficient evaluation of carotid artery lesions by eliminating artifacts such as aliasing and overwriting.

Anahtar Kelimeler

Ultrsonography, B-Flow, Doppler, Atherosclerosis, Carotid Artery, Stenosis

Kaynakça

• Kurt JJ, Raymond DA, Eugene B, Robert GP, Jean DW: Harrison´s Principles of Internal Medicine. 1980. S:1158-1166.
• Barnett HJM, Taylor DW, Eliasziw M, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. N Engl J Med1998;339:1415-1425.
• North American Symptomatic Carotid Endarterectomy Trial Collaborators, Barnett HJM, Taylor DW, Haynes RB, Sackett DL, Peerless SJ, Ferguson GG, Fox AJ, Rankin RN, Hachinski VC, Wiebers DO, Eliasziw M. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991 Aug 15;325(7):445-53.
• Bluth El, Kay D, Merritt CR Sullivan MA: Sonographic characterization of carotid artery plaque: detection of hemorrhage. AJR 146:1061-1065, 1986.
• Bogousslavsky J, Regli F, Melle GV: Risk factors and concomitants of internal carotid artery occlusion or stenosis. Arch Neurol 42: 864-67, 1985.
• Sterpetti AV, Hunter WJ, Schultz RD. Importance of ulceration of carotid plaque in determining symptoms of cerebral ischemia. J Cardiovasc Surg (Torino). 1991 Mar-Apr;32(2):154-8.
• Digital subtraction angiography of the carotid arteries: a comparative study in 100 patients. Chilcote WA, Modic MT, Pavlicek WA, Little JR, Furlan AJ, Duchesneau PM, Weinstein MA Radiology. 1981 May; 139(2):287-95.
• Adla T, Adlova R. Multimodality Imaging of Carotid Stenosis. Int J Angiol. 2015;24(3):179-184. doi:10.1055/s-0035-1556056.
• Anderson CM, Saloner D, Lee RE, Griswold VJ, Shapeero LG, Rapp JH, Nagarkar S, Pan X, Gooding GA: Assessment of carotid artery stenosis by MR angiography and color-coded Doppler ultrasound. AJNR Am J Neuroradiol 13:989-1003, 1992.
• Bom K, de Boo J, Rijsterborgh H: On the aliasing problem in pulsed Doppler cardiac studies. J Clin Ultrasound 12:559-567, 1984.
• Horn Mi Michelini M, Greisler HP, et al. Carotid endarterectomy without arteriography: the preeminent role of the vascular laboratory. Ann Vasc Surg 8:221-225, 1994.
• Turnipseed WD, Kennell TW, Turski PA, et al. Magnetic resonance angiography and duplex imaging: noninvasive tests for selecting symptomatic carotid endarterectomy candidates. Surgery 114:643-647, 1993.
• Tegos TJ, Sohail M, Sabetai MM, Robless P, Akbar N, Pare G, Dansby G, Nicolaides AN. Echomorphologic and histopathologic characteristics of unstable carotid plaques. Am J Neuroradiol 21:1937-1944, 2000
• Imparato A, Riles T, Gorstein F. The carotid bifurcation plaque: pathologic findings associated with cerebral ischemia. Stroke 10:238-244, 1979.
• Moneta GL, Edwards JM, Chitwood RW. Correlation of North American Symptomatic Carotid Endarterectomy Trial (NASCET) angiographic definition of 70% to 99% internal carotid artery stenosis with duplex scanning. J Vasc Surg 17:152-159, 1993.
• Sterpetti AV, Schultz RD, Feldhaus RJ, Davenport KL, Richardson M, Farina C, Hunter WJ. Ultrasonographic features of carotid plaque and the risk of subsequent neurologic deficits. Surgery 104: 652-660, 1998.
• Hood DB, Mattos MA, Mansour A, et al. Prospective evaluation of new duplex criteria to identify 70% internal carotid artery stenosis. J Vasc Surg 23:254-261, 1996.
• Reiter M, Horvat R, Puchner S, Rinner W, Polterauer P, Lammer J, Minar E, Bucek RA. Plaque imaging of the internal carotid artery - correlation of B-flow imaging with histopathology. AJNR Am J Neuroradiol. 2007 Jan;28(1):122-6.
• Bucek RA, Reiter M, Koppensteiner I, Ahmadi R, Minar E, Lammer J. B-flow evaluation of carotid arterial stenosis: initial experience. Radiology 225(1): 295-9, 2002.
• Jung EM, Kubale R, Clevert DA, Lutz R, Rupp N., B-flow and contrast medium-enhanced power Doppler (Optison(R)) preoperative diagnosis of high-grade stenosis of the internal carotid artery. Rofo 174(1): 62-9, 2002.
• Umemura A, Yamada K. B-mode flow imaging of the carotid artery. Stroke 32(9): 2055-7,2001.
• Referans22. Yurdakul M, Tola M, Cumhur T. B-flow imaging of internal carotid artery stenosis: Comparison with power Doppler imaging and digital subtraction angiography. J Clin Ultrasound 32(5): 243-8, 2004.
• Referans23. Mikami T, Takahashi A, Houkin K. Evaluation of blood flow in carotid artery stenosis using B-flow sonography. Neurol Med Chir (Tokyo) 43(11): 528-32, 2003.