The Value of Contrast-Enhanced Ultrasound in the Evaluation of Carotid Web

Abstract

ObjectivesThe purpose of this study was to investigate whether contrast-enhanced ultrasound (CEUS) is more advantageous than conventional ultrasound in the diagnosis of carotid web (CaW) and to compare the clinical characteristics of patients in different age groups.MethodsSeventeen patients admitted to the hospital from October 2019 to December 2021 were included in our study. Patients were initially diagnosed with CaW using digital subtraction angiography (DSA), and conventional ultrasound and CEUS were completed. Baseline patient data were analyzed and compared between the <60 years old CaW group and the ≥60 years old CaW group to explore the differences between the two groups. Then, comparing the accuracy of conventional ultrasound and CEUS.ResultsA total of 17 CaW patients participated in this study, including 4 female patients (23.5%) and 13 male patients (76.5%), with an average age of 59.41 (±10.86) years. There were 9 patients (52.9%) with left CaW and 8 patients (47.1%) with right CaW. Acute ischemic stroke (AIS) occurred in 14 patients (82.4%). Thrombosis occurred in five of 17 patients (29.4%). There was a significant statistical difference about the thrombosis between the <60 years old CaW group and the ≥60 years old CaW group [<60 years group: 0 (0%), ≥60 years group: 5 (62.5%), P = 0.005]. Seven patients (41.2%) received medical management, nine patients (52.9%) had carotid artery stenting (CAS), and one patient (5.9%) had carotid endarterectomy (CEA). None of the patients had recurrent stroke during the follow-up period. The diagnostic rate of CaW and thrombus by CEUS was higher than that by conventional ultrasound, and there was a significant statistical difference in the diagnosis of thrombus between CEUS and conventional ultrasound (χ2 = 4.286, P = 0.038).ConclusionsCEUS may have a higher diagnostic accuracy for CaW with thrombosis, and it has a higher clinical application prospect.

Sensitivity and Accuracy of Doppler Ultrasound Compared to CT Angiography for the Diagnosis of Carotid Webs: Systematic Review

“…Applying specific protocols to DUS might enhance sensitivity of this imaging method. The article that used contrast-enhanced ultrasound reported a better delineation of the lesion and the absence of microbubbles infiltration as relevant features to differentiate atherosclerotic plaques from CaW [39]. Also, microflow imaging allowed a better delineation of webs and could further identify anechoic CaW not recorded using B-mode DUS, reaching a sensitivity to detect CaW of 95% compared to CTA in that retrospective study [35].…”

The carotid web: Current research status and imaging features

“…Three-dimensional ultrasound imaging can depict the anatomical structure of the carotid web using three-dimensional multiplanar reconstruction ( Gao et al, 2022 ). Contrast agent infusion delays and filling defects were observed using contrast-enhanced ultrasonography ( Zhou et al, 2022 ). Intravascular ultrasound provides a dynamic view of the vessel lumen using an ultrasonic mini-probe with a catheter technique, and the carotid web presents with a banding hypoechoic signal connecting to the vessel wall ( Hassani et al, 2020 ).…”

Transient Perivascular Inflammation of the Carotid Artery (TIPIC): Vascular Ultrasonography Role

“…There is also the prospect of using contrast-enhanced ultrasound (CEUS) to investigate TIPIC findings, just as CEUS has been promising for the detection of flow on Doppler arising from neovascularization within carotid plaques 2,6 and also in cases of carotid membranes. 7…”