ULTRASOUND: Vascular
Case Author: Deborah Rubens, MD, University of Rochester
History
61-year-old woman without symptoms undergoing preoperative evaluation for cardiac surgery.
Imaging Findings
Sagittal spectral color Doppler image of the distal right common carotid artery (A) yields a peak systolic velocity of 51 cm/s. Sagittal spectral color Doppler image of the right internal carotid artery (ICA) (B) shows peak systolic velocity is 191 cm/s. Gray-scale sagittal ultrasound image of the right ICA (C) shows tortuosity of the vessel. Sagittal color and spectral Doppler image of the left ICA (D) shows a peak systolic velocity of 69 cm/s.
Diagnosis
Tortuous vessel
Teaching Points
Elevated peak systolic velocity is one of several criteria for stenosis and has to be corroborated with other criteria, including peak systolic velocity ratio between the internal and common carotid arteries and with gray-scale imaging. The Society of Radiologists in Ultrasound consensus conference criteria for 50–69% stenosis include a peak systolic velocity of 125–230 cm/s in the internal carotid and an internal to common carotid artery ratio of 2.0–4.0.
If the elevated velocity does not correspond to the gray-scale imaging findings, other physiologic factors that can elevate velocity, such as hypermetabolic state, contralateral obstruction, and vessel tortuosity, should be considered and correlated with clinical and imaging data.
Dissection could simulate a stenosis in the patent lumen if the other lumen is long and occluded. Dissection typically presents with low velocity and an erratic and irregular waveform in the false lumen. Gray-scale imaging should show the dissection flap or a thrombosed lumen.
Suggested Readings
Grant EG, Benson CB, Moneta GL, et al. Carotid artery stenosis: gray-scale and Doppler US diagnosis—Society of Radiologists in Ultrasound consensus conference. Radiology 2003; 229:340–346
Robbin, ML, Lockhart MB. Carotid artery ultrasound interpretation using a pattern recognition approach. Ultrasound Clin 2006; 1:111–131
This page is updated with new content weekly. It was last updated on June 19, 2018.