Review: Discordant findings in color-coded duplex-sonography and magnetic resonance angiography in symptomatic internal carotid artery stenosis: implications for diagnostic work-up and early intervention

Abstract

Background: Magnetic resonance angiography (MRA) is supposed to be the new ’gold standard’ in the diagnosis of atherosclerotic disease of the extracranial arteries.

Methods: A case report is presented on a patient in whom discordant findings of the status of the left internal carotid artery (ICA) were identified in color-coded duplex-sonography and MRA.

Results: Left ICA stenosis was suspected in duplex-sonography, yet not confirmed in contrast-enhanced (CE) MRA reconstruction. Diagnosis was confirmed after surgery and in subsequent analysis of the original CE-MRI data.

Conclusions: The analysis of source images must not be missed in MRA examinations. Conventional duplex-sonography may be superior in the estimation of the embolic potential of vascular lesions. Advanced CE techniques may therefore be adequate tools in differentiating patients eligible for carotid endarterectomy (CEA) or carotid stenting, avoiding the risk of peri-interventional iatrogenic complications. It should urgently be further improved and validated.

Keywords

carotid stenosis color-coded duplex-sonography plaque morphology CE-MRA early carotid endarterectomy

References

Aleksic, M. , Rueger, M.A. , Lehnhardt, F.G. , Sobesky, J. , Matoussevitch, V. , Neveling, M. et al. (2006) Primary stroke unit treatment followed by very early carotid endarterectomy for carotid artery stenosis after acute stroke . Cerebrovasc Dis 22: 276-281.

Anzalone, N. , Scotti, R. and Iadanza, A. ( 2006) MR angiography of the carotid arteries and intracranial circulation: advantage of a high relaxivity contrast agent. Neuroradiology 48(Suppl. 1): 9-17.

Ballotta, E. , Meneghetti, G. , Da Giau, G. , Manara, R. , Saladini, M. and Baracchini, C. ( 2008) Carotid endarterectomy within 2 weeks of minor ischemic stroke: a prospective study. J Vasc Surg 48: 595-600.

Coli, S. , Magnoni, M. , Sangiorgi, G. , Marrocco-Trischitta, M.M. , Melisurgo, G. , Mauriello, A. et al. (2008) Contrast-enhanced ultrasound imaging of intraplaque neovascularization in carotid arteries: correlation with histology and plaque echogenicity. J Am Coll Cardiol 52: 223-230.

Nederkoorn, P.J. , van der Graaf, Y. and Hunink, M.G. ( 2003) Duplex ultrasound and magnetic resonance angiography compared with digital subtraction angiography in carotid artery stenosis; a systematic review. Stroke 34: 1324-1331.

Skjelland, M. , Krohg-Sørensen, K. , Tennøe, B. , Bakke, S.J. , Brucher, R. and Russell, D. (2009) Cerebral microemboli and brain injury during carotid artery endarterectomy and stenting. Stroke 40: 230-234.

Spence, J.D. ( 2006) Technology insight: ultrasound measurement of carotid plaque - patient management, genetic research, and therapy evaluation. Nat Clin Pract Neurol 2: 611-619.

U-King-Im, J.M. , Tang, T. , Moustafa, R.R. , Baron, J.C. , Warburton, E.A. and Gillard, J.H. ( 2007) Imaging the cellular biology of the carotid plaque. Int J Stroke 2: 85-96.