Ernst Michael Jung MD, Abstract Co-Author: Nothing to Disclose

Nikolaus Rupp, Abstract Co-Author: Nothing to Disclose

Karl-Peter Jungius MD, Presenter: Nothing to Disclose

To assess the utility of ultrasound DSA (US DSA), also known as B-flow, in the evaluation of filiform stenosis of the internal carotid artery (ICA).

In a prospective study, 90 patients with tentative diagnosis of either filiform stenosis or occlusion of the ICA were examined by means of US DSA, using both available modes: brightness mode and color-coded mode.. A comparison with the color-coded duplex sonography (CCDS) and power Doppler imaging (PDI) was carried out at the same time. Each US study was performed by independently two examiners experienced with vascular US for at least 10 years. A selective X-ray DSA was available for all cases. Thirty-two patients with filiform ICA stenosis underwent surgery. The surgical findings were likewise enlisted for the comparison.

Correct diagnosis of ICA occlusion - confirmed by X-ray DSA - was achieved in all 42 cases with CCDS, PDI, and US DSA. Filiform ICA stenosis was recognized with US DSA in all 48 cases, with PDI in 44 cases, and with CCDS in 39 cases. US-DSA allowed better to visualize simultaneously the imaging of pre-, intra- and post-stenotic flow phenomena in the longitudinal scan than with PDI or CCDS. The length of the stenotic segment determined with the different US modalities was distinctly closer for US DSA than for PDI and CCDS, compared to intraarterial DSA. Ulcerated plaques with poorly echogenic thrombi could be identified in all 12 cases with US DSA - consistent with the surgical findings, in 10 cases with PDI, and in 8 cases with CCDS. Using US DSA, the intra- and post-stenotic flow visualization was possible without overlapping the vessel in all 48 patients suffering from filiform ICA stenosis.

Compared to PDI and CCDS, US DSA permitted better identification of filiform ICA stenosis without Doppler artifacts. Ulcerated plaque with thrombus can be evaluated with greater reliability.

Jung, E, Rupp, N, Jungius, K, Diagnosis and Characterization of Filiform Stenoses of the Internal Carotid Artery with Ultrasound DSA (B-flow): A Prospective Study of 90 Patients.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4409604.html