Ultrasonic duplex scanning in atherosclerotic disease of the innominate, subclavian and vertebral arteries. A comparative study with angiography

Abstract

Abstract-Ultrasonic duplex scanning of the vertebral artery has a sensitivity of 0.80 and a specificity of 0.83 for the detection of an obstructive lesion of 50% or more at the site of the ostium. For the subclavian arteries these values are respectively 0.73 and 0.91. For both vessels the test has a very high negative predictive value of respectively 0.96 and 0.97. Therefore duplex ultrasound scanning is a reliable test in screening patients suspected of multi-level atherosclerotic disease of the extracranial cerebral vessels. The problem remains in classifying the degree of stenosis. In the case of the vertebral artery the sample volume of the pulsed Doppler is usually too large in relation to the vessel diameter. In the case of the subclavian and innominate artery one of the main problems is the range of the pulsed Doppler system. A subclavian steal syndrome is easily diagnosed without any special test.

Color-coded Doppler imaging of normal vertebral arteries.

“…Moreover, the duplex scan did not satisfactorily display the ostium of 28 vertebral arteries. In contrast to Ackerstaff et al, 4 using duplex sonography Touboul et al 7 were able to visualize the pretransverse and intertransverse segments in all of 50 healthy subjects. The ostium was seen in 47 persons on the right side and in 30 on the left.…”

“…Acker- staff et al 4 reported that 31 of 117 vertebral arteries studied could not be identified with the duplex scanning system. Moreover, the duplex scan did not satisfactorily display the ostium of 28 vertebral arteries.…”

Duplex ultrasonography for the detection of vertebral artery stenosis

“…Doppler samples were taken and Peak Systolic Velocity (PSV) was recorded. Criteria used for grading ≥50% stenosis were focal elevated blood flow velocity with a PSV cut-off point at the V1 segment of the vertebral artery of 140 cm/s and 125 cm/s at the V2 segment (Ackerstaff et al, 1984(Ackerstaff et al, , 1988Hua et al, 2009;Koch, Romano, Park, Amir, & Forteza, 2009). …”

Accuracy of Color-Doppler in the Quantification of Proximal Vertebral Artery Stenoses

“…Previous studies concerning the quantification of proximal VA stenosis by ultrasound are not recent and are limited in number [10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23]. They used continuous-wave Doppler sonography [13, 21]and Duplex scanning [10, 11, 12, 14, 15, 18, 19]without color Doppler.…”

“…They used continuous-wave Doppler sonography [13, 21]and Duplex scanning [10, 11, 12, 14, 15, 18, 19]without color Doppler. Only 5 recent papers have used color-coded Doppler for examination of the vertebral arteries [16, 17, 20, 22, 23].…”