New Technologies in the Assessment of Carotid Stenosis: Beyond the Color-Doppler Ultrasound—High Frame Rate Vector-Flow and 3D Arterial Analysis Ultrasound

Abstract

Atherosclerotic plaque in the carotid artery is the main cause of ischemic stroke, with a high incidence rate among people over 65 years. A timely and precise diagnosis can help to prevent the ischemic event and decide patient management, such as follow up, medical, or surgical treatment. Presently, diagnostic imaging techniques available include color-Doppler ultrasound, as a first evaluation technique, computed tomography angiography, which, however, uses ionizing radiation, magnetic resonance angiography, still not in widespread use, and cerebral angiography, which is an invasively procedure reserved for therapeutically purposes. Contrast-enhanced ultrasound is carving out an important and emerging role which can significantly improve the diagnostic accuracy of an ultrasound. Modern ultrasound technologies, still not universally utilized, are opening new horizons in the arterial pathologies research field. In this paper, the technical development of various carotid artery stenosis diagnostic imaging modalities and their impact on clinical efficacy is thoroughly reviewed.

The evaluation value of intracranial magnetic resonance angiography combined with carotid ultrasound in cerebral infarction

“… 25 Therefore, MRA combined with CU can comprehensively examine cerebral blood vessels and cervical arteries, comprehensively evaluate the patient’s condition, and avoid missed diagnosis or misdiagnosis. 26 …”

“…25 Therefore, MRA combined with CU can comprehensively examine cerebral blood vessels and cervical arteries, comprehensively evaluate the patient's condition, and avoid missed diagnosis or misdiagnosis. 26 Limitations: First, it is a single-center retrospective study, which may be subject to selection bias due to incomplete medical records. Second, neither group was randomly assigned, and baseline information may be imbalanced and biased.…”

Contrast-Enhanced Ultrasound Feasibility in Assessing Carotid Plaque Vulnerability—Narrative Review

“…However, it is essential to keep in mind that CEUS shares the limitations of conventional ultrasound. It relies on the operator's skill and may not provide sufficient information in certain scenarios such as when dealing with large and calcified plaques [118]. Moreover, traditional US imaging is constrained by its ability to assess intravascular events beyond a specific threshold of molecular expression.…”

The impact of V-flow on preoperative diagnosis of thyroid tumors: individually and as part of multimodal sonographic imaging

“…Both qualitative and quantitative data were reproducible by two separate investigators. Since no prior experience with the application of Vflow for a thyroid gland has been reported, the technical preset of this mode had to be modified for both high-flow arteries and low-flow veins [10,12]. 23 cm/s was the lowest velocity V-flow was able to measure.…”

“…After injecting a contrast agent, contrast-enhanced ultrasound (CEUS) can depict perfusion patterns including smaller blood vessels [7,8]. The new V-flow mode goes beyond these techniques by providing dynamic visualization of microvascularization up to capillary perfusion, even showing the movement of single erythrocytes [9,10,11,12]. Despite not being incorporated into the TI-RADS classification, intranodular perfusion holds promise as an additional criterion for enhancing the accuracy of thyroid nodule assessment.…”