Journal of Ultrasound in Medicine, Vol 13, Issue 9 659-664, Copyright © 1994 by American Institute of Ultrasound in Medicine
Ultrasonic features of extracranial carotid dissections: 47 cases studied by angiography
J. M. de Bray, P. Lhoste, F. Dubas, J. Emile and J. L. Saumet
Vascular Investigations Department, University Hospital, Angers, France.
The purpose of this prospective study was to assess the value of continuous
wave Doppler velocimetry, standard duplex scanning and color Doppler flow
imaging in the diagnosis of carotid dissections. From 1975 to 1993, 42
patients (mean age, 44 +/- 14 years) were admitted to the University
Hospital of Angers for a carotid dissection studied first by
ultrasonography, then defined by angiography. Five cases were bilateral.
Continuous wave Doppler examination revealed signs of severe obstruction of
the carotid arteries in 96% of the cases (occlusion, extensive
submandibular tight stenoses, significant slowdowns in the carotid and
ophthalmic vessels, retrograde ophthalmic blood flow). Standard duplex
scanning suggested dissection in 72% of the cases (tapering stenoses or
occlusion, segmental ectasis, tubular vessel, peripheral residual channel,
or rare irregular "membrane"). Color Doppler flow imaging suggested a
dissection in 82% of the cases. This method has the advantage of
underlining the peripheral channel, the double lumen, and the dissecting
hematoma, which often is hypoechoic. The ultrasonic methods (continuous
wave Doppler combined with color Doppler flow imaging) failed only when
they are performed late and when moderate or segmental intrapetrosal
dissections were present. These ultrasonic investigations would thus appear
to be useful for early diagnosis of carotid dissections.
