Improved diagnosis of vascular dissection by ultrasound B-flow: a comparison with color-coded Doppler and power Doppler sonography

The purpose was to evaluate the diagnostic results of different ultrasound techniques: color-coded Doppler (CCD), power Doppler (PD) and B-flow in the diagnosis of vascular dissection. Findings from 68 patients with arterial dissection proven either by vascular ultrasound (US) or by magnetic resonance angiography (MRA), computed tomographic angiography (CTA) or intra-arterial digital subtraction angiography (DSA) were reviewed in retrospect. The study compared results from three different modes of ultrasound, i.e., CCD, PD and B-flow, in dissections of the carotid artery (n=11), of the vertebral artery (n=9), of the abdominal aorta (n=13), of the iliac artery (n=12) and of the femoral artery (n=23). MRA, CTA and DSA were considered as reference standard. The sensitivity of CCD for detecting all dissections was 78%, 84% for the PD and 98% for B-flow. For carotid artery dissection, the sensitivity of CCD, PD and B-flow was 82, 91 and 98%, for the vertebral artery 67, 78 and 98%, for the abdominal aorta 85, 85 and 98%, for the iliac artery 67, 75 and 98%, for the femoral artery 83, 87 and 98%, respectively. Intima flaps, fissures of membranes and residual flow within the true and false lumen were better detected by B-flow than by CCD and PD. The lack of angle dependence of the US probe in B-flow made the examination procedure easier. In the cine mode of B-flow, the pulse synchronic movement of the membrane was more apparent than in any other imaging method. With B-flow, accuracy for the diagnosis of arterial dissection is improved compared to CCD and PD. Flow within the true and false lumen, low-echo thrombi, intramural hematoma and even movements of the dissection membrane are clearly distinguished.