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Title: US of neurovascular occlusive disease : interpretive pearls and pitfalls
Authors: Romero, JM
Lev, MH
Chan, ST
Connelly, MM
Curiel, RC
Jackson, AE
Gonzalez, RG
Ackerman, RH
Keywords: Carotid arteries, stenosis or obstruction
Carotid arteries, US
Subclavian steal syndrome
Ultrasound (US), Doppler studies
Vertebral arteries, US
Issue Date: 2002
Publisher: Radiological Society of North America
Source: Radiographics, 2002, v. 22, no. 5, p. 1165-1176 How to cite?
Journal: Radiographics 
Abstract: Ultrasonography (US) of the head and neck is a convenient but operator-dependent screening tool for detection and diagnosis of neurovascular occlusive disease. In US examination of the extracranial carotid arteries, stenosis is most commonly graded according to the peak systolic Doppler velocity in the region of maximal luminal narrowing rather than according to the percentage of atheromatous plaque occupying the lumen. However, the peak systolic velocity is not always reliable in estimation of the degree of stenosis. General diagnostic pitfalls include technical difficulties with scanning, failure to review the spectral waveform patterns, the presence of additional stenotic lesions, and anatomic variants. Specific examples of pitfalls include tandem lesions, differentiation of pseudo-occlusion from true total occlusion, pseudonormalization of velocities in cases of very severe stenosis, lesions of the carotid artery origin or aortic valve, progression of subclavian steal, underestimation of severe stenosis due to heavily calcified plaque, a persistent trigeminal artery, and contralateral carotid artery stenosis. Although conventional angiography remains the standard of reference for assessment of carotid artery disease, recognition of these common sources of error in US can improve the accuracy of this noninvasive test in diagnosis of carotid artery occlusion.
ISSN: 0271-5333
EISSN: 1527-1323
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