Duplex Ultrasonography of Vertebral Arteries: Examination, Technique, Normal Values, and Clinical Applications

Abstract

A technique for the imaging of vertebral arteries at their origins and along the longitudinal extracranial course is described. The results of the examination of 108 normal vertebral arteries are shown. The vertebral artery could be distinguished in the pretransverse and intertransverse segment C5-C6 in 100%. The average diameter of the vessel was 3.81 +/- 0.46 mm on the right and 3.88 +/- 0.47 on the left side. The average maximal systolic velocity was 43.0 +/- 8.9 cm/s on the right and 43.3 +/- 9.6 on the left side. In 81% of the cases the vertebral origin could be located on the right and in 65% of the cases on the left side. The technical quality of visualization, especially of the vertebral origin, was greatly influenced by the depth of the examined structure. Examples of pathologic findings, such as hypoplasia, stenosis, and occlusion, demonstrate the practical possibilities of this noninvasive method.

Reference Values for Vertebral Artery Flow Volume by Duplex Sonography in Young and Elderly Adults

“…2 Our results for systolic and diastolic velocities are also comparable to 9,12,13 or slightly lower than 15,16 those found in other studies. Reference values for TAV and TAMX thus far exist only for children 10 and young adults 9 ; the latter are in substantial accordance with the values found in the present study.…”

Blood flow and flow resistance in the vertebral arteries of patients with and without carotid atherosclerosis

“…In the present investigation, the intertransversal diameter was 3·2 mm in vertebral arteries without flow abnormalities. This is slightly less than reported earlier for healthy younger subjects (Bartels et al. , 1992; Schöning et al.…”

“…Using modern ultrasonographic technique in experienced hands, the origin of the vertebral artery could be visualized in 70% of the vertebral arteries. This was somewhat disappointing because similar or slightly better results have been reported earlier using older techniques (Touboul et al, 1986;Trattnig et al, 1990;Bartels et al, 1992). However, earlier studies were based on younger persons and healthy volunteers, who presumably were easier to scan than our consecutive series of older patients.…”

'Cardiogenic vertigo'—true vertigo as the presenting manifestation of primary cardiac disease

“…In cadaveric studies, unilateral congenital hypoplasia of one vertebral artery occurs in 9% of individuals, 14 but side-to-side asymmetries in diameter and flow are even more common, and can be found in up to 33% of healthy individuals, generally with the left side 'dominant.' 15 Thus, although we have no direct evidence to support our specula tions on the pathogenesis of 'cardiogenic vertigo' in this particular patient, we believe our explanation provides a plausible and testable hypothesis to explain why such a phenomenon might occur so frequently in patients with cardio vascular disease, as has been empirically shown by others. 8,9 …”