Ultragarsinės diagnostikos reikšmė vertinant miego arterijų stenozės laipsnį

Author: Tural Abdullayev. Supervisor: MD Ph.D. Antanas Jankauskas. Department of Radiology, LUHS Kaunas Clinics. Research title: Diagnostic value of ultrasound in the evaluation of carotid artery stenosis. Keywords: carotid artery stenosis, carotid artery disease, transient ischemic attack, vulnerable plaques, vasa vasorum, carotid duplex ultrasound, computed tomography angiography, contrast-enhanced ultrasound. Aim: To evaluate the diagnostic value of ultrasound in the evaluation of carotid artery stenosis Objectives: 1) to evaluate the morphology of plaque on ultrasound and computed tomography; 2) to evaluate the prognostic value of ultrasound determined plaque morphology; 3) to evaluate the degree of stenosis of the carotid artery on ultrasound and computed tomography Methodology: A literature research was done for publications evaluating the diagnostic performance of DUS, CTA, or a combination of these two modalities in patients with carotid artery stenosis. To find the studies, PUBMED search was performed using the following keywords, and all related terms: carotid artery stenosis, duplex ultrasound, computed tomography angiography, carotid artery disease, transient ischemic attack. All reviewed studies were published in the English language. In addition, all the associated articles and reference lists of original publications on this topic was checked. Results: In included 3 studies (387 patients, 774 arteries) the sensitivity of the US in the evaluation of the complicated plaques was significantly low comparing to that of MDCTA. However, DUS has satisfactory specificity and sensitivity in the detection of unstable plaques. Observed studies including 826 patients have suggested that CEUS may be an appropriate an initial non-invasive method for determination of a vulnerable plaque. In 6 included studies (699 patients, 1263 arteries) DUS was less reliable for 50-69% stenoses and more suitable in diagnosing 70-99% stenoses. Nevertheless, the use of additional non-invasive imaging modality shows better results than a DUS alone. Conclusions: Based on the analyzed data, DUS is inferior to MDCT in evaluation morphological characteristics of the plaque. Many studies have confirmed CEUS as a reliable noninvasive method in the evaluation of carotid plaque vulnerability. Nevertheless, the diagnostic accuracy of contrast ultrasound in the determination of the histological degree of vasa vasorum remains controversial. CDUS is demonstrating better performance in evaluating high degree stenosis and occluded arteries; however, it is less reliable in the detection of mild to moderately stenosed vessels. CTA is illustrating better results in the assessment of stenosis in carotid arteries, nevertheless, errors can be observed while evaluating mild to moderately stenosed vessels, and therefore a combination of these techniques can be more effective in the evaluation of stenosis in carotid arteries.