EURORAD ESR

Case 15393

The value of multiparametric ultrasound (MPUS) in a case of pre-occlusive internal carotid artery stenosis with ulceration; correlation with MDCTA and MRA.

Author(s)
Vasileios Rafailidis1, Ioannis Chryssogonidis1, Georgios Papadopoulos1, Chrysostomos Xerras2, Thomas Tegos2, Anna Kalogera-Fountzila1

1. Department of Radiology, AHEPA University General Hospital of Thessaloniki, Greece.
2. 1st Neurological Department, AHEPA University General Hospital of Thessaloniki, Greece.
Email:billraf@hotmail.com
 
Patient
male, 55 year(s)
 
 
  • Figure 1
    US and CEUS findings
     

    Colour Doppler US image showing the presence of a partially calcified plaque situated at the internal carotid artery bulb and causing loss of blood flow signals distally, raising suspicion of occlusion (asterisk).

     
    Area of Interest: Arteries / Aorta; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Diagnostic procedure; Special Focus: Arteriosclerosis;

    Pulsed-wave Doppler interrogation at the point of limited blood flow signals documented antegrade flow with low velocity, suggesting the presence of patent lumen.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Arteriosclerosis;

    B-Flow technique image readily revealing the presence of patent lumen in combination with linear superficial ulcerations (arrowheads) within the hypoechoic part of the plaque.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Arteriosclerosis;

    CEUS image after the administrartion of 2.4 ml of microbubbles confirmed the patency of internal carotid artery while accurately delineating the superficial ulcerations (arrowheads).

     
    Area of Interest: Arteries / Aorta; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Arteriosclerosis;
     
     
  • Figure 2
    CTA findings (performed two years prior to presentation)
     

    Axial image showing the patent residual internal carotid artery lumen (arrowhead), the ulcer cavity (asterisk) and a mural calcification (arrow).

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Arteriosclerosis;

    MIP image showing an ulcerated plaque causing severe stenosis of the internal carotid artery. Except for the proximal large ulcer cavity, two linear areas of enhancement are identified, possibly corresponding to...

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Arteriosclerosis;

    3D Volume Rendering Technique showing the affected carotid bifurcation. Note that the presence of calcification hides the ulcer’s cavity, preventing its accurate detection in VRT images.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Arteriosclerosis;
     
     
  • Figure 3
    MRA findings
     

    MIP contrast-enhanced MRA image confirming the presence of an ulcerated plaque causing pre-occlusive stenosis of the internal carotid artery.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: MR-Angiography; Procedure: Diagnostic procedure; Special Focus: Arteriosclerosis;

    Axial image showing the residual lumen (arrowhead) and the ulcer cavity (arrow). Note that the calcification is not visualized due to loss of signal.

     
    Area of Interest: Arteries / Aorta; Imaging Technique: MR-Angiography; Procedure: Diagnostic procedure; Special Focus: Arteriosclerosis;
     
     
Colour Doppler US image showing the presence of a partially calcified plaque situated at the internal carotid artery bulb and causing loss of blood flow signals distally, raising suspicion of occlusion (asterisk).
 
Pulsed-wave Doppler interrogation at the point of limited blood flow signals documented antegrade flow with low velocity, suggesting the presence of patent lumen.
 
B-Flow technique image readily revealing the presence of patent lumen in combination with linear superficial ulcerations (arrowheads) within the hypoechoic part of the plaque.
 
CEUS image after the administrartion of 2.4 ml of microbubbles confirmed the patency of internal carotid artery while accurately delineating the superficial ulcerations (arrowheads).
 
Axial image showing the patent residual internal carotid artery lumen (arrowhead), the ulcer cavity (asterisk) and a mural calcification (arrow).
 
MIP image showing an ulcerated plaque causing severe stenosis of the internal carotid artery. Except for the proximal large ulcer cavity, two linear areas of enhancement are identified, possibly corresponding to shallow superficial ulcerations.
 
3D Volume Rendering Technique showing the affected carotid bifurcation. Note that the presence of calcification hides the ulcer’s cavity, preventing its accurate detection in VRT images.
 
MIP contrast-enhanced MRA image confirming the presence of an ulcerated plaque causing pre-occlusive stenosis of the internal carotid artery.
 
Axial image showing the residual lumen (arrowhead) and the ulcer cavity (arrow). Note that the calcification is not visualized due to loss of signal.
 
 
 
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