Advantages and Pitfalls of Three-Dimensional Ultrasound Imaging of Carotid Bifurcation

Abstract

Objectives: Several specialists use three-dimensional (3D) ultrasound as adjuvant imaging technique in their clinical practice. It has been applied to study carotid plaque morphology, surface and volume during atherosclerosis progression. Nonetheless, no papers have so far described the use of this technique in conditions different than carotid stenosis, such as bifurcation anatomy changes of the caliber and vessel course modifications. Methods: Patients admitted to our ultrasound laboratory for vascular screening were submitted to standard carotid duplex and to 3D ultrasound reconstruction of the carotid bifurcation. Results: Forty normal subjects, 7 patients with caliber alterations (4 carotid bulb ectasia and 3 internal carotid lumen narrowing), 45 patients with course variations (tortuosities and kinking) and 35 patients with internal carotid artery stenosis of various degrees have been investigated. Conclusions: 3D ultrasound is a feasible technique. It can improve carotid axis imaging through a better presentation of caliber variations and vessel course ‘at a glance’. 3D ultrasound from the inward flow can provide imaging of the stenosis, but stenosis quantification should always take into account the assessment of plaque morphology and vessel wall.

Three-dimensional ultrasonographic evaluation of carotid artery plaque surface irregularity

“…Three-dimensional imaging was successfully performed in 45 of the 50 cases and the technical success was 90%. In 5 of the cases, 3D volumes could not be evaluated properly because of a reverberation artifact in two cases (in near wall located carotid plaques, optimal images cannot be obtained because of the near wall that causes sonographic reverberation artifacts) and patient incompliance in 3 other cases (short patient neck and high carotid bifurcation), similarly as in the literature [14]. The plaques ranged from 2 to 12 mm in length (mean: 3.98 ±1.70 mm) and from 1.8 to 3.2 mm in width (mean: 2.11 ±0.37 mm).…”

Evaluation of Freehand B-Mode and Power-Mode 3D Ultrasound for Visualisation and Grading of Internal Carotid Artery Stenosis

“…Although 3DUS software algorithms are nowadays implemented in most high-end ultrasound systems they are scarcely used for 3DUS, despite some benefit for examination of carotid vessels which has been demonstrated in previous studies [12, 17]. This is probably due to different technical restrictions associated with the scanning process like the necessity to move the ultrasound transducer with constant velocity and without tilting which is often not achievable in a common ultrasound examination.…”

“…First, it is unclear which ultrasound mode should be the basis for 3DUS, e.g. 3DUS based on high-resolution native B-mode ultrasound [11, 16, 18] or 3DUS based on power mode [10, 12, 14, 15, 17]. Together with recent advances in (3D) ultrasound technology, native B-mode ultrasound allows visualisation of carotid vessels with high temporal and spatial resolution [18], but hypoechogenic or heavily calcified plaques still remain important limitations and restricted 3D visualisation of ICAS in 16% of cases in our previous study [18].…”

Correlation between Doppler Velocities and Duplex Ultrasound Carotid Cross-sectional Percent Stenosis

“…In fact, by using the same technique and by means of two kinds of evaluation (ie, morphological cross-sectional evaluation and Doppler parameters categorization), we could have two complementary findings at the same time. Obviously, in the case of discrepancy between duplex findings and clinical results, further complementary tool is required, for example by means of spiral computed tomography angiography (16) or threedimensional ultrasound imaging (37,38).…”