Transoral carotid ultrasonography with superb microvascular imaging

Abstract

Transoral carotid ultrasonography (TOCU) is a powerful tool for evaluating ICA lesions located from carotid bifurcation to the second cervical vertebra. In recent case reports, contrast-enhanced transoral carotid ultrasonography (CETOCU), which is essentially TOCU performed with perfluorobutane microbubbles as the ultrasonography contrast agent, produces clear intraluminal image of extracranial ICA, which is not possible with conventional carotid artery ultrasonography (CUS). Superb microvascular imaging (SMI) is a new Doppler imaging technique that employs a unique algorithm to minimize motion artifacts by eliminating clutter signals based on analysis of tissue movement. SMI significantly reduces motion artifacts and allows visualization of low-velocity blood flow in vessels. CUS with SMI and contrast enhanced carotid ultrasound are similar in images, and evaluate plaque neovascularization. We performed TOCU with SMI to two healthy persons, in order to examine similarity between CETOCU and TOCU with SMI. Although there were some inadequacies for small lesions, we found that TOCU with SMI can obtain images similar to CETOCU. TOCU with SMI is expected to be applied to clinical use.

Diagnostic Performance of Atherosclerotic Carotid Plaque Neovascularization with Contrast-Enhanced Ultrasound: A Meta-Analysis

“…With the development of atherosclerosis, various local and systemic factors will promote neovascularization. Neovascularization in plaque (IPN) is one of the important characteristics of vulnerable plaque formation [5,6]. Due to the lack of support of vascular smooth muscle cells and endothelial cells, vascular fragility, high permeability, white blood cells, and red blood cells exudate, leading to bleeding in plaque [7,8].…”