What is the role of ultrasound in stroke imaging?

Updated: Nov 30, 2018
  • Author: Andrew Danziger; Chief Editor: L Gill Naul, MD  more...
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Answer

Doppler ultrasound is the most common imaging examination performed for the diagnosis of carotid stenosis worldwide. The prevalence of significant (50%) stenotic disease in symptomatic patients is stated as being in the range of 18-20%, while the prevalence in asymptomatic patients with clinical markers for significant atherosclerotic disease who are referred for carotid imaging is 14%. [58, 59, 96, 97]

All sonographic examinations of the carotid arteries should be performed using grayscale, color Doppler ultrasound, and spectral Doppler ultrasound analysis to detect luminal patency, presence of plaque, dissection flaps, velocity, and direction of blood flow.

Changes in both plaque texture and plaque volume have been shown to be strongly predictive of vascular events. In high-risk patients, 3D ultrasound plaque measurements should be considered for prediction of the risk of vascular event. [98] Grayscale images provide a gross analysis of luminal patency and assessment of calcified or soft plaque and intimal thickening. Color and power Doppler ultrasound measurements can depict residual lumen in cases of high-grade stenosis to better advantage than grayscale images. Spectral Doppler provides velocity measurements that are used to specifically grade stenosis.


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