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Kontrastverstärkte Ultraschallbildgebung der A. carotis

Contrast-enhanced ultrasound imaging of the carotid artery

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Zusammenfassung

Der Ultraschall mit B-Bild-, Continuous-wave- (CW-)Spektral- und Farbdopplersonographie steht heute am Anfang der Diagnostik der hirnversorgenden Gefäße und besitzt einen hohen Stellenwert in der bildgebenden Diagnostik. Diese Standarduntersuchungsverfahren ermöglichen die gleichzeitige Erfassung morphologischer und hämodynamischer Befunde mit einer hohen örtlichen und zeitlichen Auflösung. Die meisten pathologischen Veränderungen der extrakraniellen hirnversorgenden Gefäße können damit sicher erfasst werden.

Die kontrastmittelverstärkte Sonographie („contrast-enhanced ultrasound“, CEUS) ist eine neue und viel versprechende Methode für die nichtinvasive Diagnose komplexer pathologischer Gefäßveränderungen. Als spezielle Anwendungen sind die sichere Abgrenzung eines A.-carotis-interna- (ACI-)Verschlusses vs. Pseudookklusion, eine verbesserte Beurteilung von Instentstenosen, die präzise Darstellung extrakranieller ACI-Aneurysmen und die zuverlässige Diagnostik von Dissektionen zu nennen.

In diesem Beitrag werden Methodik und diagnostische Aussagekraft von farbkodierter Duplexsonographie (FKDS) und CEUS bei verschiedenen pathologischen Veränderungen der extrakraniellen Abschnitte der A. carotis dargestellt und diskutiert.

Abtract

A conventional grey scale, Doppler sonography and color-coded Doppler ultrasound examination should be the first step in the diagnosis of the vessels supplying the brain and have a major impact in diagnostic imaging. This ultrasound examination allows the simultaneous acquisition of morphologic and hemodynamic information with high spatial and temporal resolution. Most of the pathological changes of the extracranial arteries can thus be reliably detected. Contrast-enhanced ultrasound (CEUS) is a promising new non-invasive method for the diagnosis and follow-up of complex carotid abnormalities. In addition to improving current carotid structural scans, CEUS has the potential to improve or provide additional information on carotid arterial diseases, such as the reliable differentiation between internal carotid artery (ICA) occlusion and pseudo-occlusion, improved visualization of in-stent stenosis, extracranial ICA aneurysms and carotid dissection.

In this article the contribution of color-coded duplex ultrasound and CEUS in assessing various pathologies of the carotid artery will be addressed.

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Literatur

  1. (o A) (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 325(7):445–453

    Google Scholar 

  2. (o A) (1995) Risk of stroke in the distribution of an asymptomatic carotid artery. The European Carotid Surgery Trialists Collaborative Group. Lancet 345(8944):209–212

    Google Scholar 

  3. AbuRahma AF, Abu-Halimah S, Bensenhaver J et al (2008) Optimal carotid duplex velocity criteria for defining the severity of carotid in-stent restenosis. J Vasc Surg 48(3):589–594

    Article  PubMed  Google Scholar 

  4. AbuRahma AF, Pollack JA, Robinson PA, Mullins D (1997) The reliability of color duplex ultrasound in diagnosing total carotid artery occlusion. Am J Surg 174(2):185–187

    Article  PubMed  CAS  Google Scholar 

  5. Adams HP Jr, Bendixen BH, Kappelle LJ et al (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24(1):35–41

    PubMed  Google Scholar 

  6. Armstrong PA, Bandyk DF, Johnson BL et al (2007) Duplex scan surveillance after carotid angioplasty and stenting: a rational definition of stent stenosis. J Vasc Surg 46(3):460–465; discussion 465–466

    Article  PubMed  Google Scholar 

  7. Carballo RE, Towne JB, Seabrook GR et al (1996) An outcome analysis of carotid endarterectomy: the incidence and natural history of recurrent stenosis. J Vasc Surg 23(5):749–753; discussion 753–744

    Article  PubMed  CAS  Google Scholar 

  8. Chahwan S, Miller MT, Pigott JP et al (2007) Carotid artery velocity characteristics after carotid artery angioplasty and stenting. J Vasc Surg 45(3):523–526

    Article  PubMed  Google Scholar 

  9. Clevert D-A, Helck A, Reiser M (2011) Duplex and contrast enhanced ultrasound (CEUS) in evaluation of in-stent restenosis after carotid stenting. Clin Hemorheol Microcirc, in press

  10. Clevert D-A, Helck A, Saam T, Reiser M (2011) Improved carotid atherosclerotic plaques imaging with contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc, in press

  11. Clevert D-A, Graser A, Jung EM et al (2008) Value of ultrasound in the diagnosis of aneurysms of the extracranial internal carotid arteries. Clin Hemorheol Microcirc 39(1–4):133–146

    Google Scholar 

  12. Clevert D-A, Horng A, Kopp R et al (2009) Imaging of endoleaks after endovascular aneurysm repair (EVAR) with contrast-enhanced ultrasound (CEUS). Radiologe 49(11):1033–1039

    Article  PubMed  Google Scholar 

  13. Clevert D-A, Horng A, Reiser MF (2009) Ultrasound imaging of the abdominal aorta. Radiologe 49(11):1024–1032

    Article  PubMed  Google Scholar 

  14. Clevert D-A, Johnson T, Jung EM et al (2007) Color Doppler, power Doppler and B-flow ultrasound in the assessment of ICA stenosis: comparison with 64-MD-CT angiography. Eur Radiol 17(8):2149–2159

    Article  PubMed  Google Scholar 

  15. Clevert D-A, Johnson T, Michaely H et al (2006) High-grade stenoses of the internal carotid artery: comparison of high-resolution contrast enhanced 3D MRA, duplex sonography and power Doppler imaging. Eur J Radiol 60(3):379–386

    Article  PubMed  Google Scholar 

  16. Clevert D-A, Jung EM, Johnson T et al (2007) Cervical artery dissection: improved diagnosis by B-flow ultrasound. Clin Hemorheol Microcirc 36(2):141–153

    PubMed  Google Scholar 

  17. Clevert D-A, Rupp N, Reiser M, Jung EM (2005) Improved diagnosis of vascular dissection by ultrasound B-flow: a comparison with color-coded Doppler and power Doppler sonography. Eur Radiol 15(2):342–347

    Article  PubMed  Google Scholar 

  18. Clevert D-A, Sommer WH, Zengel P et al (2011) Imaging of carotid arterial diseases with contrast-enhanced ultrasound (CEUS). Eur J Radiol, in press

  19. Cumbie T, Rosero EB, Valentine RJ et al (2008) Utility and accuracy of duplex ultrasonography in evaluating in-stent restenosis after carotid stenting. Am J Surg 196(5):623–628

    Article  PubMed  Google Scholar 

  20. De Jong KP, Zondervan PE, van Urk H (1989) Extracranial carotid artery aneurysms. Eur J Vasc Surg 3(6):557–562

    Article  Google Scholar 

  21. Dziewas R, Konrad C, Drager B et al (2003) Cervical artery dissection – clinical features, risk factors, therapy and outcome in 126 patients. J Neurol 250(10):1179–1184

    Article  PubMed  Google Scholar 

  22. Eisenberg RL, Nemzek WR, Moore WS, Mani RL (1977) Relationship of transient ischemic attacks and angiographically demonstrable lesions of carotid artery. Stroke 8(4):483–486

    PubMed  CAS  Google Scholar 

  23. Fine-Edelstein JS, Wolf PA, O’Leary DH et al (1994) Precursors of extracranial carotid atherosclerosis in the Framingham Study. Neurology 44(6):1046–1050

    PubMed  CAS  Google Scholar 

  24. Furst G, Saleh A, Wenserski F et al (1999) Reliability and validity of noninvasive imaging of internal carotid artery pseudo-occlusion. Stroke 30(7):1444–1449

    PubMed  CAS  Google Scholar 

  25. Gray WA, Hopkins LN, Yadav S et al (2006) Protected carotid stenting in high-surgical-risk patients: the ARCHeR results. J Vasc Surg 44(2):258–268

    Article  PubMed  Google Scholar 

  26. Groschel K, Riecker A, Schulz JB et al (2005) Systematic review of early recurrent stenosis after carotid angioplasty and stenting. Stroke 36(2):367–373

    Article  PubMed  Google Scholar 

  27. Guillon B, Bousser MG (2002) Epidemiology and pathophysiology of spontaneous cervical artery dissection. J Neuroradiol 29(4):241–249

    PubMed  CAS  Google Scholar 

  28. Gurm HS, Yadav JS, Fayad P et al. (2008) Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med 358(15):1572–1579

    Article  PubMed  CAS  Google Scholar 

  29. Hermus L, van Dam GM, Zeebregts CJ (2010) Advanced carotid plaque imaging. Eur J Vasc Endovasc Surg 39(2):125–133

    Article  PubMed  CAS  Google Scholar 

  30. Horng A, Reiser M, Clevert D-A (2009) Current developments in vascular ultrasound. Radiologe 49(11):998–1004

    Article  PubMed  CAS  Google Scholar 

  31. Hwang CS, Liao KM, Lee JH, Tegeler CH (2003) Measurement of carotid stenosis: comparisons between duplex and different angiographic grading methods. J Neuroimaging 13(2):133–139

    PubMed  Google Scholar 

  32. Mathias K, Jager H, Hennigs S, Gissler HM (2001) Endoluminal treatment of internal carotid artery stenosis. World J Surg 25(3):328–334; discussion 334–326

    Article  PubMed  CAS  Google Scholar 

  33. Moore WS, Kempczinski RF, Nelson JJ, Toole JF (1998) Recurrent carotid stenosis: results of the Asymptomatic Carotid Atherosclerosis Study. Stroke 29(10):2018–2025

    PubMed  CAS  Google Scholar 

  34. Neff KW, Kilian AK, Meairs S, Duber C (2005) Correlation of duplex sonographic stenosis grading by means of cross-sectional analysis and MR-tomographic blood volume flow quantification in unilateral stenosis of the internal carotid artery. Rofo 177(7):992–999

    PubMed  CAS  Google Scholar 

  35. Schulte-Altedorneburg G, Clevert D-A (2009) Color duplex sonography of extracranial brain-supplying arteries. Radiologe 49(11):1016–1023

    Article  PubMed  CAS  Google Scholar 

  36. Siablis D, Karnabatidis D, Katsanos K et al (2004) Extracranial internal carotid artery aneurysms: report of a ruptured case and review of the literature. Cardiovasc Intervent Radiol 27(4):397–401

    Article  PubMed  Google Scholar 

  37. Sidhu PS, Allan PL (1997) The extended role of carotid artery ultrasound. Clin Radiol 52(9):643–653

    Article  PubMed  CAS  Google Scholar 

  38. Sidhu PS, Allan PL, Cattin F et al (2006) Diagnostic efficacy of SonoVue, a second generation contrast agent, in the assessment of extracranial carotid or peripheral arteries using colour and spectral Doppler ultrasound: a multicentre study. Br J Radiol 79(937):44–51

    Article  PubMed  CAS  Google Scholar 

  39. Van der Vaart MG, Meerwaldt R, Reijnen MM et al (2008) Endarterectomy or carotid artery stenting: the quest continues. Am J Surg 195(2):259–269

    Article  Google Scholar 

  40. Yadav JS, Wholey MH, Kuntz RE et al (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351(15):1493–1501

    Article  PubMed  CAS  Google Scholar 

  41. Zhang Q, Duan ZQ, Xin SJ et al (1999) Management of extracranial carotid artery aneurysms: 17 years‘ experience. Eur J Vasc Endovasc Surg 18(2):162–165

    PubMed  CAS  Google Scholar 

  42. Zhou W, Felkai DD, Evans M et al (2008) Ultrasound criteria for severe in-stent restenosis following carotid artery stenting. J Vasc Surg 47(1):74–80

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland

    D.-A. Clevert, A. Helck, P.M. Paprottka & M.F. Reiser

  2. Institut für Röntgendiagnostik, Universitätsklinikum Regensburg (UKR), Regensburg, Deutschland

    E.M. Jung

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  1. D.-A. Clevert
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  2. A. Helck
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  3. P.M. Paprottka
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  4. M.F. Reiser
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  5. E.M. Jung
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Correspondence to D.-A. Clevert.

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Clevert, DA., Helck, A., Paprottka, P. et al. Kontrastverstärkte Ultraschallbildgebung der A. carotis. Radiologe 51, 483–489 (2011). https://doi.org/10.1007/s00117-010-2102-x

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