Multiparametric 3D Contrast-Enhanced Ultrasound to Assess Internal Carotid Artery Stenosis: A Pilot Study

Extracranial internal carotid artery stenoses (ICASs) may greatly differ with respect to morphological and hemodynamical aspects. The aim of this pilot study was to evaluate the use of multiparametric 3-dimensional (3D) contrast-enhanced ultrasound (3D-CEUS) to comprehensively examine ICAS.

Fifteen patients with moderate to severe ICAS were examined with multiparametric 3D-CEUS, power-mode 3D ultrasound (3DUS), color-coded duplex sonography (CDS), and digital subtraction angiography (DSA) (n = 9). Multiparametric 3D-CEUS comprised the assessment of the morphology and the stenotic degree of ICAS and the measurement of the ipsistenotic cerebral circulation time (CCT).

Multiparametric 3D-CEUS reliably visualized even complex aspects of ICAS such as ulcerated or heavily calcified plaques with high spatial resolution. When comparing the different methods to quantify ICAS, the intermethod agreement was good (ranging from poor to excellent) between 3D-CEUS and CDS, moderate (ranging from poor to good) between 3D-CEUS and DSA, and poor (ranging from poor to good) between CDS and DSA. The CCT was significantly longer in patients with ICAS than in healthy subjects (8.2 ± 1.5 seconds vs. 6.5 ± 1.3 seconds, P = .026).

In this pilot study, bedside multiparametric 3D-CEUS provided reliable estimations of different morphological and hemodynamical aspects of ICAS, thus ideally complementing CDS.