Native 3D-US angiography of carotid vessels shows good interrater and intermethod agreement in comparison to CE-MRA. Together with a moderate to good intermethod and interrater agreement in the quantification of ICAS, when compared to 2D-CDS, 3D-US angiography is thus a promising complementary imaging technique for carotid artery disease.
BackgroundCurrently, colour-coded duplex sonography (2D-CDS) is clinical standard for detection and grading of internal carotid artery stenosis (ICAS). However, unlike angiographic imaging modalities, 2D-CDS assesses ICAS by its hemodynamic effects rather than luminal changes. Aim of this study was to evaluate freehand 3D ultrasound (3DUS) for direct visualisation and quantification of ICAS.MethodsThirty-seven patients with 43 ICAS were examined with 2D-CDS as reference standard and with freehand B-mode respectively power-mode 3DUS. Stenotic value of 3D reconstructed ICAS was calculated as distal diameter respectively distal cross-sectional area (CSA) reduction percentage and compared with 2D-CDS.ResultsThere was a trend but no significant difference in successful 3D reconstruction of ICAS between B-mode and power mode (examiner 1 {Ex1} 81% versus 93%, examiner 2 {Ex2} 84% versus 88%). Inter-rater agreement was best for power-mode 3DUS and assessment of stenotic value as distal CSA reduction percentage (intraclass correlation coefficient {ICC} 0.90) followed by power-mode 3DUS and distal diameter reduction percentage (ICC 0.81). Inter-rater agreement was poor for B-mode 3DUS (ICC, distal CSA reduction 0.36, distal diameter reduction 0.51). Intra-rater agreement for power-mode 3DUS was good for both measuring methods (ICC, distal CSA reduction 0.88 {Ex1} and 0.78 {Ex2}; ICC, distal diameter reduction 0.83 {Ex1} and 0.76 {Ex2}). In comparison to 2D-CDS inter-method agreement was good and clearly better for power-mode 3DUS (ICC, distal diameter reduction percentage: Ex1 0.85, Ex2 0.78; distal CSA reduction percentage: Ex1 0.63, Ex2 0.57) than for B-mode 3DUS (ICC, distal diameter reduction percentage: Ex1 0.40, Ex2 0.52; distal CSA reduction percentage: Ex1 0.15, Ex2 0.51).ConclusionsNon-invasive power-mode 3DUS is superior to B-mode 3DUS for imaging and quantification of ICAS. Thereby, further studies are warranted which should now compare power-mode 3DUS with the angiographic gold standard imaging modalities for quantification of ICAS, i.e. with CTA or CE-MRA.
Freehand 3DUS of the median nerve over 20 cm is feasible and may help overcome some of the limitations and pitfalls of 2DUS. Muscle Nerve 55: 206-212, 2017.
BACKGROUND AND PURPOSEExtracranial internal carotid artery stenoses (ICASs) may greatly differ with respect to morphological and hemodynamical aspects. The aim of this pilot study was to evaluate the use of multiparametric 3‐dimensional (3D) contrast‐enhanced ultrasound (3D‐CEUS) to comprehensively examine ICAS.METHODSFifteen patients with moderate to severe ICAS were examined with multiparametric 3D‐CEUS, power‐mode 3D ultrasound (3DUS), color‐coded duplex sonography (CDS), and digital subtraction angiography (DSA) (n = 9). Multiparametric 3D‐CEUS comprised the assessment of the morphology and the stenotic degree of ICAS and the measurement of the ipsistenotic cerebral circulation time (CCT).RESULTSMultiparametric 3D‐CEUS reliably visualized even complex aspects of ICAS such as ulcerated or heavily calcified plaques with high spatial resolution. When comparing the different methods to quantify ICAS, the intermethod agreement was good (ranging from poor to excellent) between 3D‐CEUS and CDS, moderate (ranging from poor to good) between 3D‐CEUS and DSA, and poor (ranging from poor to good) between CDS and DSA. The CCT was significantly longer in patients with ICAS than in healthy subjects (8.2 ± 1.5 seconds vs. 6.5 ± 1.3 seconds, P = .026).CONCLUSIONIn this pilot study, bedside multiparametric 3D‐CEUS provided reliable estimations of different morphological and hemodynamical aspects of ICAS, thus ideally complementing CDS.
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