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Sutedjo V, Tirindelli M, Eilers C, Simson W, Busam B, Navab N. Acoustic Shadowing Aware Robotic Ultrasound: Lighting up the Dark. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3141451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Murai Y, Sekine T, Ishisaka E, Tsukiyama A, Kubota A, Matano F, Ando T, Nakae R, Morita A. Factors Influencing Long-Term Blood Flow in Extracranial-to-Intracranial Bypass for Symptomatic Internal Carotid Artery Occlusive Disease: A Quantitative Study. Neurosurgery 2022; 90:426-433. [PMID: 35064659 DOI: 10.1227/neu.0000000000001846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Maintaining the patency of extracranial-to-intracranial (EC-IC) bypass is critical for long-term stroke prevention. However, reports on the factors influencing long-term bypass patency and quantitative assessments of bypass patency are limited. OBJECTIVE To quantitatively evaluate blood flow in EC-IC bypass using four-dimensional (4D) flow magnetic resonance imaging (MRI) and investigate factors influencing the long-term patency of EC-IC bypass. METHODS Thirty-six adult Japanese patients who underwent EC-IC bypass for symptomatic internal carotid or middle cerebral artery occlusive disease were included. We examined the relationships between decreased superficial temporal artery (STA) blood flow volume and perioperative complications, long-term ischemic complications, patient background, and postoperative antithrombotic medications in patients for whom STA flow could be quantitatively assessed for at least 5 months using 4D flow MRI. RESULTS The mean follow-up time was 54.7 ± 6.1 months. One patient presented with a stroke during the acute postoperative period that affected postoperative outcomes. No recurrent strokes were recorded during long-term follow-up. Two patients died of malignant disease. Seven cases of reduced flow occurred in the STA, which were correlated with single bypass (P = .0294) and nonuse of cilostazol (P = .0294). STA occlusion was observed in 1 patient during the follow-up period. Hypertension, age, smoking, dyslipidemia, and diabetes mellitus were not correlated with reduced blood flow in the STA. CONCLUSION Double anastomoses and cilostazol resulted in long-term STA blood flow preservation. No recurrence of cerebral infarction was noted in either STA hypoperfusion or occlusion cases.
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Affiliation(s)
- Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Tetsuro Sekine
- Department of Radiology, Musashi-Kosugi Hospital, Nippon Medical School, Kanagawa, Japan
| | - Eitaro Ishisaka
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Atsushi Tsukiyama
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Asami Kubota
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Takahiro Ando
- Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan
| | - Ryuta Nakae
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
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Abstract
A key assumption in ultrasound is that the reflected echoes that return to the transducer travel in a straight line. Mirror image artifacts occur when the transmitted pulse and returning echo reflect off of a highly reflective interface (an acoustic mirror) and change direction before returning to the transducer, thereby breaking this assumption. Mirror image artifacts are seen throughout the body on gray scale, color Doppler, power Doppler, and spectral Doppler. They may closely duplicate the true structure in shape and echo strength, may distort the true structure, may appear weaker than the true structure, or may appear on images that do not simultaneously show the true structure. If not properly recognized, mirror image artifacts can be misinterpreted as true pathology and lead to additional unnecessary tests and potentially harmful interventions.
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Seyman EE, Bornstein N, Auriel E, Cohen O, Nissel T, Hallevi H. Assessment of carotid artery ultrasonography in the presence of an acoustic shadow artifact. BMC Neurol 2019; 19:178. [PMID: 31357950 PMCID: PMC6664737 DOI: 10.1186/s12883-019-1405-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/18/2019] [Indexed: 11/22/2022] Open
Abstract
Background B-mode and Color Doppler ultrasonography (CDUS) are the methods of choice for screening and determining the degree of Carotid artery stenosis. The evaluation of stenosis with calcification may be hampered by a common CDUS artifact known as acoustic shadow (AS). Our objective was to assess the change in reliability of CDUS readings in the presence of an AS artifact. Methods Single center retrospective observational study. Included were patients with either an AS artifact or high-grade stenosis (defined by peak systolic velocity (PSV) > 240 cm/s) demonstrated in CDUS, and had a CT angiography (CTA) done within 6 months of the sonographic exam. All subjects were identified through the Tel-Aviv Sorasky medical center (TASMC) CDUS unit registry from which clinical information was extracted. CDUS images were manually reviewed grading AS magnitude. All CTAs were reviewed and reconstructed for accurate assessment of percent stenosis and were used as gold standard. Results The study cohort included 227 consecutive patients (corresponding with 454 internal carotid arteries) meeting inclusion criteria. 43.2% of the arteries (n = 195) had an AS artifact present on CDUS, regardless of percent stenosis, with a large artifact present in 6.7% arteries (n = 30). Older age was significantly related to the presence of AS artifact (p < 0.001). In the study cohort as a whole there was a strong correlation between percent stenosis on CTA and PSV values (Pearson’s r 0.672, p < 0.001) regardless of AS existence. The CDUS sensitivity and specificity for predicting severe stenosis were 82 and 73% respectively. The presence of a small AS slightly diminished the correlation between CDUS and CTA results without compromising CDUS reliability. A large AS severely affected the correlation between CDUS and CTA exams (Pearson’s r = 0.24, p = 0.27) and reduced CDUS reliability with a sensitivity and specificity of 62%. Conclusion The presence of a large AS severely degrades the accuracy of the routine CDUS measurements. In these cases, the patient should be referred to a CDUS exam including doppler-measurement of periorbital arteries and intracranial arteries in addition to other imaging modalities such as CTA or MRA in order to assess future stroke risk.
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Affiliation(s)
- Estelle E Seyman
- Division of Neurology, Stroke Department, Tel-Aviv Sorasky Medical Center, 6 Weizmann St., Tel Aviv-Jaffa, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv-Jaffa, Israel.
| | - Natan Bornstein
- Department of Neurology Shaarey-Tzedek Medical Center, 12 Shmuel Bait Street, Jerusalem, Israel
| | - Eitan Auriel
- Department of Neurology, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv-Jaffa, Israel
| | - Oren Cohen
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Jaffa, Israel
| | - Tania Nissel
- Division of Neurology, Stroke Department, Tel-Aviv Sorasky Medical Center, 6 Weizmann St., Tel Aviv-Jaffa, Israel
| | - Hen Hallevi
- Division of Neurology, Stroke Department, Tel-Aviv Sorasky Medical Center, 6 Weizmann St., Tel Aviv-Jaffa, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv-Jaffa, Israel
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Rafailidis V, Chryssogonidis I, Xerras C, Nikolaou I, Tegos T, Kouskouras K, Rafailidis D, Charitanti-Kouridou A. A comparative study of color Doppler imaging and contrast-enhanced ultrasound for the detection of ulceration in patients with carotid atherosclerotic disease. Eur Radiol 2018; 29:2137-2145. [PMID: 30350162 DOI: 10.1007/s00330-018-5773-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/14/2018] [Accepted: 09/18/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of color Doppler imaging (CDI) and contrast-enhanced ultrasound (CEUS) for diagnosing carotid ulceration, having multi-detector computed tomography angiography (MDCTA) as the reference method. METHODS Patients with carotid disease referred for ultrasound (US), either due to the occurrence of neurovascular symptoms or for screening purposes, were included in this study if at least one plaque causing moderate (50-69%) or severe (70-99%) internal carotid artery stenosis was detected. Carotid US with CDI technique, CEUS, and MDCTA were performed in all patients, investigating the presence of ulceration. The agreement between modalities was evaluated using kappa statistics. RESULTS The study population included 54 patients (median age 62 years, inter-quartile range 16.2) and 66 carotid arteries. The mean degree of stenosis was 68.5% (SD 12.2%) while 47.1% of plaques were symptomatic. MDCTA characterized 28.8% of plaques as smooth, 45.5% irregular, and 24.3% ulcerated. Flow reversal was detected with CDI in 65.5% of ulcerations, while swirling of the microbubbles and neovessels adjacent to the ulcer were detected with CEUS in 17.64%. The agreement for ulceration diagnosis was moderate between CDI and CEUS (kappa 0.473) and between CDI and MDCTA (kappa 0.473) and very good between CEUS and MDCTA (kappa 0.921). The sensitivity, specificity, and positive and negative predictive values of CDI for the diagnosis of ulceration were 41.2%, 97.95%, 87.5%, 82.8% respectively, while CEUS respective measures were 94.1%, 97.95%, 94.1%, and 97.95%. CONCLUSION CEUS outperformed CDI in terms of agreement with MDCTA and diagnostic accuracy for the diagnosis of ulcerated carotid plaque. KEY POINTS • Superficial ulceration is a significant feature of carotid plaque vulnerability. • Color Doppler imaging has the potential to demonstrate carotid plaque ulceration but is characterized by limited sensitivity and moderate agreement with the reference method of multi-detector computed tomography angiography. • Contrast-enhanced ultrasound outperforms color Doppler imaging in terms of sensitivity for the detection of carotid plaque ulceration and in agreement with the reference method of multi-detector computed tomography angiography.
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Affiliation(s)
- Vasileios Rafailidis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Ioannis Chryssogonidis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chrysostomos Xerras
- 1st Neurological Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Irini Nikolaou
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Tegos
- 1st Neurological Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Kouskouras
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Rafailidis
- Department of Radiology, "G. Gennimatas" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Charitanti-Kouridou
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Rafailidis V, Chryssogonidis I, Tegos T, Kouskouras K, Charitanti-Kouridou A. Imaging of the ulcerated carotid atherosclerotic plaque: a review of the literature. Insights Imaging 2017; 8:213-225. [PMID: 28160261 PMCID: PMC5359146 DOI: 10.1007/s13244-017-0543-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/02/2017] [Accepted: 01/09/2017] [Indexed: 02/01/2023] Open
Abstract
Abstract Carotid atherosclerotic disease constitutes a major modern health problem whose diagnosis primarily relies on imaging. Grading of stenosis has been long used as the main factor for risk stratification and guiding of management. Nevertheless, increasing evidence has shown that additional plaque characteristics such as plaque composition and surface morphology play an important role in the occurrence of symptoms, justifying the term “vulnerable plaque”. Carotid plaque surface characteristics either in the form of surface irregularities or ulceration represent an important factor of vulnerability and are associated with the occurrence of neurologic symptoms. The delineation of the carotid plaque surface can be performed with virtually all imaging modalities including ultrasound, contrast-enhanced ultrasound, multi-detector computed tomography angiography, magnetic resonance angiography and the traditional reference method of angiography. These techniques have shown varying levels of diagnostic accuracy for the identification of ulcerated carotid plaques or plaque surface irregularities. As a consequence and given its high clinical significance, radiologists should be familiar with the various aspects of this entity, including its definition, classification, imaging findings on different imaging modalities and associations. The purpose of this review is to present the current literature regarding carotid plaque ulcerations and present illustrative images of ulcerated carotid plaques. Teaching Points • Plaque surface and ulceration represent risk factors for stroke in carotid disease. • Characterisation of the plaque surface and ulcerations can be performed with every modality. • US is the first-line modality for carotid disease and identification of ulcerations. • The administration of microbubbles increases US accuracy for diagnosis of carotid ulceration. • MDCTA and MRA are valuable for diagnosing ulceration and evaluating plaque composition.
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Affiliation(s)
- Vasileios Rafailidis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Ioannis Chryssogonidis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Tegos
- 1st Neurological Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Kouskouras
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Charitanti-Kouridou
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Mohebali J, Patel VI, Romero JM, Hannon KM, Jaff MR, Cambria RP, LaMuraglia GM. Acoustic shadowing impairs accurate characterization of stenosis in carotid ultrasound examinations. J Vasc Surg 2016; 62:1236-44. [PMID: 26506272 DOI: 10.1016/j.jvs.2015.06.137] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 06/04/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Duplex ultrasonography (DUS) has been the mainstay for diagnosing carotid artery stenosis and is often the sole diagnostic modality used prior to intervention. Highly calcified plaque, however, results in an acoustic shadow (AcS) that obscures the vessel lumen and inhibits the sonographer's ability to obtain Doppler velocity measurements. It is unknown whether DUS can accurately determine the degree of carotid stenosis in these settings. METHODS From July 2012 to December 2013, all patients with AcS on DUS measuring ≥5 mm in the longitudinal axis were cross-referenced with multidetector computed tomographic angiography (MD-CTA) images of the neck to define the study population. After standardizing the MD-CTA windows, percent stenosis was determined by cross-sectional area reduction using two separate previously described methods based on North American Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST) criteria. DUS waveform parameters in the internal carotid artery near the AcS were then compared with these MD-CTA measurements to determine the accuracy of DUS in characterizing the severity of carotid stenosis. RESULTS During this period, 8517 DUS studies were performed at the Massachusetts General Hospital, 550 of which had AcS, for an incidence of 6.45%. There were 92 lesions with a concomitant MD-CTA; however, seven were excluded because of poor study quality, because ≥6 months had elapsed between DUS and MD-CTA, or because the patient had undergone carotid reconstruction between studies. Of the 85 remaining lesions, DUS characterized 17 as severe (peak systolic velocity [PSV] >250 cm/s), 31 as moderate (PSV = 151-250 cm/s), and 37 as mild (PSV ≤150 cm/s) stenoses using PSV criteria. PSV weakly correlated with CTA-NASCET (r = 0.361; P = .004) and CTA-ECST (r = 0.306; P = .004) percent stenosis. Using PSV >250 cm/s as the predictor of >70% stenosis, and a ≥70% cutoff by both CTA-ECST and CTA-NASCET methods as the reference measure, DUS sensitivity ranged from 22.7% to 32.5%, specificity from 89.4% to 91.1%, positive predictive value from 88.2% to 76.4%, and negative predictive value from 25% to 60.2%. A subgroup analysis of lesions identified as non-severe by DUS revealed that waveforms with lower deceleration were associated with severe stenosis on CTA. CONCLUSIONS In the presence of AcS, DUS alone is inadequate to accurately determine the degree of carotid stenosis with sensitivity, specificity, and negative predictive values far below that needed for clinical decision-making. MD-CTA may be necessary for improved characterization of plaque in these AcS lesions. Further studies are needed to determine DUS parameters that may identify patients who should undergo further evaluation with MD-CTA to characterize the true severity of the stenosis.
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Affiliation(s)
- Jahan Mohebali
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - Virendra I Patel
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass; Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - Javier M Romero
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - Kathleen M Hannon
- Section of Vascular Medicine, Division of Cardiovascular Medicine, Massachusetts General Hospital Vascular Center and Harvard Medical School, Boston, Mass
| | - Michael R Jaff
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass; Section of Vascular Medicine, Division of Cardiovascular Medicine, Massachusetts General Hospital Vascular Center and Harvard Medical School, Boston, Mass
| | - Richard P Cambria
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass; Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - Glenn M LaMuraglia
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass; Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass.
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Yiu BYS, Lai SSM, Yu ACH. Vector projectile imaging: time-resolved dynamic visualization of complex flow patterns. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2295-309. [PMID: 24972498 DOI: 10.1016/j.ultrasmedbio.2014.03.014] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 03/02/2014] [Accepted: 03/10/2014] [Indexed: 05/22/2023]
Abstract
Achieving non-invasive, accurate and time-resolved imaging of vascular flow with spatiotemporal fluctuations is well acknowledged to be an ongoing challenge. In this article, we present a new ultrasound-based framework called vector projectile imaging (VPI) that can dynamically render complex flow patterns over an imaging view at millisecond time resolution. VPI is founded on three principles: (i) high-frame-rate broad-view data acquisition (based on steered plane wave firings); (ii) flow vector estimation derived from multi-angle Doppler analysis (coupled with data regularization and least-squares fitting); (iii) dynamic visualization of color-encoded vector projectiles (with flow speckles displayed as adjunct). Calibration results indicated that by using three transmit angles and three receive angles (-10°, 0°, +10° for both), VPI can consistently compute flow vectors in a multi-vessel phantom with three tubes positioned at different depths (1.5, 4, 6 cm), oriented at different angles (-10°, 0°, +10°) and of different sizes (dilated diameter: 2.2, 4.4 and 6.3 mm; steady flow rate: 2.5 mL/s). The practical merit of VPI was further illustrated through an anthropomorphic flow phantom investigation that considered both healthy and stenosed carotid bifurcation geometries. For the healthy bifurcation with 1.2-Hz carotid flow pulses, VPI was able to render multi-directional and spatiotemporally varying flow patterns (using a nominal frame rate of 416 fps or 2.4-ms time resolution). In the case of stenosed bifurcations (50% eccentric narrowing), VPI enabled dynamic visualization of flow jet and recirculation zones. These findings suggest that VPI holds promise as a new tool for complex flow analysis.
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Affiliation(s)
- Billy Y S Yiu
- Medical Engineering Program, University of Hong Kong, Pokfulam, Hong Kong
| | - Simon S M Lai
- Medical Engineering Program, University of Hong Kong, Pokfulam, Hong Kong
| | - Alfred C H Yu
- Medical Engineering Program, University of Hong Kong, Pokfulam, Hong Kong.
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Ahn H, Hernández-Andrade E, Romero R, Ptwardhan M, Goncalves LF, Aurioles-Garibay A, Garcia M, Hassan SS, Yeo L. Mirror artifacts in obstetric ultrasound: case presentation of a ghost twin during the second-trimester ultrasound scan. Fetal Diagn Ther 2013; 34:248-52. [PMID: 24071724 DOI: 10.1159/000353702] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 06/11/2013] [Indexed: 11/19/2022]
Abstract
Mirror artifacts are produced by the reflection of ultrasound waves after they propagate through a structure and encounter a strong and smooth interface capable of acting as a mirror. Ultrasound waves bounce back and forth between the mirroring interface and the reflective object and then eventually return to the transducer. The typical display of the mirror artifact consists of two similar structures separated and at similar distances from the reflective interface. We report a mirror artifact in a patient with a singleton gestation at 18 weeks. The image was interpreted as consistent with a twin gestation using transabdominal and transvaginal ultrasound. The differential diagnosis consisted of an abdominal heterotopic pregnancy. The presence of synchronized but opposite movements of both fetuses, and the blurred image of the second fetus, suggested a mirror artifact. The reflective surface was created by the interface located between a distended rectosigmoid filled with gas and the posterior uterine wall. Mirror artifacts can lead to diagnostic errors. This case illustrates how a distended rectosigmoid colon can generate an image that simulates either a twin gestation or an abdominal heterotopic pregnancy.
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Affiliation(s)
- Hyunyoung Ahn
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
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Rubin JM, Gao J, Hetel K, Min R. Duplication images in vascular sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:1385-1390. [PMID: 20876891 DOI: 10.7863/jum.2010.29.10.1385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the characteristics and phenomena of duplication (or mirror) images in vascular sonography. METHODS We retrospectively reviewed 5 cases of vascular sonography that produced duplication images performed between June 30, 2009, and January 10, 2010. The 5 vascular studies included the subclavian artery (2), subclavian vein (1), carotid artery (1), and abdominal aorta (1). The characteristics of the color flow images and spectral Doppler waveforms in the artifactual vessels and in the true vessels were analyzed. Sources and mechanisms of producing duplication images were assessed. RESULTS We were able to generate color flows in the artifactual vessels that were the same as in the true vessels in 2 cases. However, we were able to generate images in which the apparent flow directions in the artifactual vessels differed from the actual flow observed in the true vessels in all 5 cases by changing the orientation of the ultrasound beam relative to the true flow and the reflecting surface. CONCLUSIONS Duplication images result from mirror reflections producing multipath artifacts. The appearance of the flow in an artifactual vessel on color Doppler imaging strongly depends on the angle of the incident sound beam and the surface structure of the strong reflector relative to the flow in the true vessel. Alternating the scanning plane and the angle of the incident sound beam to the reflector may help distinguish a duplication artifact from a true vessel in ambiguous cases.
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Affiliation(s)
- Jonathan M Rubin
- Department of Radiology, University Hospital, University of Michigan, Ann Arbor, MI 48109-5030 USA.
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Kurtz A. Mirror-Image Artifact Mimicking a Carotid Artery Dissection. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2008. [DOI: 10.1177/8756479307311913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sonographic artifacts are a common occurrence in B-mode, color, and spectral Doppler. Sonographers should be aware of the potential occurrence of these artifacts so that a normal examination is not classified as abnormal. In the case presented in this article, a mirror-image artifact from the wall of the jugular vein appeared in the common carotid artery lumen, mimicking a carotid artery dissection.
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Affiliation(s)
- Abby Kurtz
- 7860 Linda Joyce Drive, Bartlett, TN 38133,
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