Non-visualization of the internal carotid artery with a normal ipsilateral common carotid artery Doppler waveform: a finding suggesting congenital absence of the ICA on colour Doppler ultrasound

We report a case of congenital absence of the left internal carotid artery (ICA) that presented with left-sided facial numbness. On MRI of the brain, occlusion of the left cavernous ICA was suggested. On colour Doppler ultrasound (CDS), the left ICA was not visualized and the ipsilateral common carotid artery (CCA) showed normal flow in systole and diastole. Combined with the correct identification of the left external carotid artery (ECA), these findings were suggestive of congenital absence of the ICA rather than occlusion. The final diagnosis of congenital absence of the ICA was confirmed with CT of the skull base.     

Intraoperative and early postoperative colour Doppler sonography after carotid artery reconstruction: follow-up of technical defects

We studied 50 patients with intraoperative colour-coded Doppler sonography (CCDS) after carotid artery reconstruction. Technical defects could be detected in 19 cases (38 %): residual plaques in 9, flaps in 8 and strictures in 2. In 9 cases (18 %) the carotid endarterectomy was revised. One residual plaque and one residual stricture caused thrombosis at the operative site a few hours postoperatively. One of the patients with residual plaques developed a high-grade stenosis within the follow-up period. Of the patients with residual plaques two had a medium-grade stenosis at follow-up. Six flaps decreased in size or disappeared within 1 week after operation. No patient with a flap developed a stenosis within the follow-up period. Our findings seem to indicate that correction of intimal flaps less than 10 mm in size is not necessary.     

The diagnostic value of colour duplex ultrasound for symptomatic carotid stenosis in clinical practice

We assessed the accuracy of colour duplex ultrasound for the detection of severe (70–99 %) symptomatic carotid stenosis in a clinical setting, in order to assess whether it could make carotid angiography unnecessary. In 152 patients with a transient ischaemic attack or non-disabling ischaemic stroke in the carotid distribution, we compared the degree of colour duplex ultrasound stenosis with angiographic stenosis by receiver-operating-characteristic analysis. The angiograms were evaluated by blinded observers, and compared with routine reports of the colour duplex examination. We computed the sensitivity and specificity of colour duplex, and the number of angiograms and sonographic studies needed to prevent one stroke within 3 years, taking into account the risks of angiography, and the risks and efficacy of endarterectomy. The estimates were adjusted for nonverification bias. We found 34 patients (22 %) with a severe (70–99 %) symptomatic carotid stenosis. In 16 patients (11 %) the symptomatic artery was occluded. The sensitivity and specificity of duplex ultrasound were 76 % and 85 %, respectively. The number of patients needed to undergo angiography to prevent one stroke was reduced from almost 200 to 33, when colour duplex was used as a preoperative examination. After adjustment for the effects of nonverification, the sensitivity dropped to 58 % and the number of duplex studies needed to prevent one stroke would double. The number of angiograms needed after positive duplex sonography would be virtually unaffected. Were colour duplex sonography to have been the sole preoperative investigation, the number needed to diagnose to prevent one stroke within 3 years would be approximately 350, more than twice as many as with the combined diagnostic strategy. The diagnostic accuracy of colour duplex sonography in clinical practice seems less impressive than previous studies have suggested, but it remains an effective way to select patients for angiography. Its use as a single preoperative assessment cannot be recommended. Received: 24 March 1998 Accepted: 21 May 1998     

Color-coded Doppler sonography of the carotid artery

A total of 844 patients were evaluated to compare the value of ultrasonography and color-flow Doppler and to demonstrate the advantage presented by the latter method. In 89%, color-flow assessment was in complete agreement with the duplex assessment. In the remaining 11%, important additional results were discovered in the color-flow examination. Non-stenotic plaques were seen more often (43%) in the wide carotid bulb; stenotic plaques and occlusion were found more often (66% and 82%) in the internal carotid artery. Color-flow Doppler allows the sonomorphological (plaques, stenoses, occlusion) and functional parameters (turbulences, flow enhancement) to be studied at the same time.     

Three-dimensional color Doppler sonography in carotid artery stenosis

BACKGROUND AND PURPOSE: Color Doppler sonography (CDS) suffers from such disadvantages as high interobserver variability and problems with data presentation and storage. We therefore performed a prospective trial to assess the role of three-dimensional CDS (3D-CDS) in the evaluation of internal carotid artery stenosis (ICAS). METHODS: We included 32 consecutive patients with sonographically verified ICAS (30-99%) and 16 asymptomatic volunteers. All underwent CDS and 3D-CDS, and 23 patients also underwent intraarterial angiography. The sensitivity, specificity, positive predictive value, and negative predictive value for the detection of high-grade ICAS were analyzed by three blinded readers, who also graded the percentage of ICAS. RESULTS: CDS revealed 14 patients with mild to moderate ICAS and 18 patients with high-grade ICAS. Mean sensitivity of 3D-CDS was 81.5%, mean specificity was 98.9%, mean positive predictive value was 97.9%, and mean negative predictive value was 89.9%. 3D-CDS correlated significantly with CDS (mean r=0.85; P<.001) and angiography (mean r=0.57; P=.01). CONCLUSION: 3D-CDS findings correlate with those obtained by CDS and angiography; 3D-CDS also offers excellent interobserver correlation, positive predictive value, and specificity, approaching 100% for the detection of high-grade ICAS.     

彩色多普勒超声在颈动脉狭窄诊断中的临床应用

目的：研究彩色多普勒超声（Color Doppler Flow Imaging,CDFI）检查对颈部动脉狭窄的诊断价值。方法：分别对115例脑血管病患者和120例正常人进行颈部动脉CDFI检查,测量双侧颈总动脉分叉处及颈内动脉后壁内膜-中膜厚度（IMT）及斑块形成情况。结果：CDFI显示,与对照组相比,疑似颈动脉狭窄组中发现206支颈动脉内膜-中膜增厚,132支伴有斑块形成,收缩期峰值血流速度、舒张末期流速均显著性增高,对照组238支颈动脉各项指标均正常。结论：CDFI可作为检查颈动脉管壁病变的一种优良的观测手段,能准确地判定颈动脉狭窄程度及狭窄位置,为临床提供可靠诊断依据,也能用作治疗后随访手段。     

The detection of intracranial carotid artery disease by continuous-wave Doppler sonography

Summary We have investigated 6,587 patients with directional continuous-wave (c-w) Doppler sonography of the carotid arteries during the last 33 months, and have developed criteria for the diagnosis of a significant increase in peripheral resistance of the internal carotid artery in conjunction with 1,671 retrograde brachial and direct carotid angiograms. We distinguished stenoses proximal (15 cases) and distal (4) to the origin of the ophthalmic artery, supraclinoid internal carotid artery occlusions (8), stenoses (2) and acute occlusions (10) of the middle cerebral artery. Stenoses in the carotid siphon (proximal or distal to the origin of the ophthalmic artery) of at least 60% reduction in lumen diameter showed a reduction of the relative end-diastolic flow velocity (modified Pourcelot's index) of more than 40%; additionally, stenoses proximal to the origin of the ophthalmic artery exhibited a variable alternating flow, or flow reversal, in the supratrochlear artery. Stenoses distal to the origin of the ophthalmic artery rarely revealed the theoretically expected increase in orthograde flow velocity in the supratrochlear artery. Stenoses of the middle cerebral artery consisting of more than atherosclerotic irregularities proved to be an exception. Supraclinoid occlusions of the internal carotid artery were reliably demonstrated by Doppler sonography. However, the majority of acute occlusions of the middle cerebral artery could not be detected by this means, probably due to anastomoses between the anterior and the middle cerebral arteries, which were detected by angiography. Thus, we believe that c-w Doppler sonography is a reliable tool to detect stenoses of the carotid siphon of more than 60% reduction in lumen diameter and supraclinoid carotid artery occlusions. Barriers to the cerebral blood flow located more peripherally cannot be diagnosed reliably with this technique.     

Colour-coded Doppler sonography of common carotid artery dissection

Colour Doppler sonography allowed noninvasive confirmation of bilateral common carotid artery dissection in a patient with previous aortic dissection. It also cast light on the pathophysiology.     

锁骨下动脉窃血综合征的彩色多普勒超声与CTA的对比研究

目的探讨锁骨下动脉窃血综合征的彩色多普勒超声与CTA特征及诊断价值。方法回顾性分析2l例锁骨下动脉(subclavian artery,SCA)窃血综合征患者的超声及CTA资料,并进行对照分析。结果锁骨下窃血综合征发生于左侧病变l4例,右侧7例,其中部分窃血6例,完全窃血14例,其中锁骨下动脉起始部闭塞5例。患侧椎动脉反向程度与该侧锁骨下动脉或无名动脉狭窄程度与CTA对照呈正相关。结论椎动脉反流是诊断锁骨下动脉窃血综合征的重要依据之一,也是超声多普勒诊断锁骨下动脉窃血综合征的优势。锁骨下动脉管腔的真实狭窄程度CTA具有绝对的优势。     

Doppler color flow imaging of common carotid artery dissection

Summary Sonographic findings are reported in a case of common carotid artery dissection assessed by Doppler color flow imaging and confirmed by angiography. Advantages and clinical relevance of this new ultrasound method for this diagnosis are discussed.     

彩色多普勒超声在颈动脉粥样硬化诊断中的应用

目的和方法 对60例分别有高血压(26例)、冠心病(20例)、脑梗塞(10例，其中高血压、冠心病合并脑梗塞8例)，脑供血不足(4例)患做颈动脉超声检查，探讨彩色多普勒超声在颈动脉粥样硬化(CAS)诊断中的应用价值。结果 60例患均有程度不等的颈动脉粥样硬化形成，其中16例为单纯内膜一中层厚度增厚，44例有粥样硬化斑块形成，占73．3％。CAS斑块好发于颈总动脉分叉处，以扁平斑多见，软斑、硬斑次之，溃疡斑最少。结论 彩色多普勒超声检测颈动脉粥样硬化有重要的临床应用价值。     

双功彩色多普勒超声检测糖尿病患者眼动脉血流量

目的：探讨双功彩色多普勒超声(CDUS)定量评价糖尿病患者眼动脉血流量的可行性。方法：糖尿病组33例66条眼动脉，正常对照30例60条眼动脉。检测指标包括眼动脉彩色血流束宽度以代表其内径(D)和平均血流速度(Vmean)，并计算每条眼动脉的血流量。结果：糖尿病组眼动脉平均内径及平均血流速度均低于正常组，进而导致其眼动脉血流量低于正常组。结论：双功CDUS是检测糖尿病患者眼动脉血流量可行且实用的技术。     

彩色多普勒超声检查颈动脉硬化患者椎动脉供血不足的价值

<正> 颈动脉硬化患者可表现出椎-基底动脉供血不足造成的一过性头晕,我们用彩色多普勒超声方法,对颈动脉硬化椎-基底动脉供血不足患者进行颅外段的椎动脉检查,通过声像图及其血流动力学参数的改变观察其变化。1资料与方法1.1一般资料收集2004～2008年我院住院及门诊100例颈动脉硬化患者,临床无耳科及眼科疾病     

Doppler ultrasound and contrast-enhanced magnetic resonance angiography in assessing carotid artery stenosis

PURPOSE: This study prospectively compares Doppler ultrasound (Doppler US) and contrast-enhanced magnetic resonance angiography (CE-MRA) with digital subtraction angiography (DSA) and endarterectomy findings to determine the accuracy in assessing carotid artery stenosis. MATERIALS AND METHODS: Thirty-two patients underwent carotid endarterectomy, 21 studied with Doppler US, CE-MRA and DSA and 11 with Doppler US and CE-MRA. In 41 carotid arteries, the degree of stenosis was analysed with Doppler US and CE-MRA and compared with DSA by using the Spearman rank correlation coefficient. Nine out of 32 endarterectomies were done using the eversion technique, and it was possible to compare Doppler US, CE-MRA and DSA with the specimen measurement. Twenty-three out of 32 endarterectomies were done using the standard technique, and the presence of ulcers was documented. RESULTS: There was a significant Doppler US/DSA (Rs=0.86; p<0.001) and CE-MRA/DSA (Rs=0.81; p<0.001) correlation for the degree of stenosis. The diagnostic accuracy of the three methods was the same (89%). Ulcers were most frequently seen at CE-MRA, with a diagnostic accuracy of 85%. CONCLUSIONS: These data suggest that endarterectomy on the basis of Doppler US and CE-MRA can be considered appropriate. CEMRA was the best noninvasive imaging modality to detect plaque ulceration.