Ulceration and Stenosis of Internal Carotid Artery Imaged by Convergent Color Doppler
A65-year-old man was admitted to our hospital because of a transient cerebral ischemic attack. Cranial CT and MRI showed no specific abnormality. Carotid imaging was performed with a newly developed convergent color Doppler (CCD), which images information on both flow velocity and Doppler signal energy simultaneously. These correspond to frequency shift and integral of Doppler frequency-power spectrum, respectively. In CCD, because the flow including high-velocity component is colored, turbulent or vortex flow was clearly distinguished from laminar flow with physiological flow velocity. The CCD flow image revealed hollowing at the inner surface of the carotid wall, depicted as blue area (arrow). This was considered as reflecting a vortex flow at the site of ulcer lesion. An accelerated poststenotic flow was demonstrated as a red area (Figure⇓, top). Two-dimensional echo could depict a clear stenotic lesion but no definite ulceration. Carotid artery angiography confirmed the ulceration and stenosis at the same site (Figure⇓, lower left) despite no observation of the lesion on MR angiography. On the basis of the CCD information, endarterectomy was performed, and the ulcer lesion with a small thrombus was confirmed pathomorphologically (Figure⇓, lower right). It is likely that a microthrombus formed in this ulceration, causing a transient ischemic attack.
This is the first report of image diagnosis of a definite ulcer lesion. From this case study, CCD was thought to be a noninvasive and feasible diagnostic modality for diagnosing atherosclerotic lesions by visualizing flow conditions in significant stenosis and ulceration. The information obtained by this technique could be of great clinical benefit for detecting the atherosclerotic lesions in carotid artery.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
- Copyright © 1999 by American Heart Association