Contrast-Enhanced Ultrasonography for Clinical Assessment of Vertebral Artery Origin Pathologies

This study aimed to assess the feasibility of contrast-enhanced ultrasound (CEUS) for vertebral artery (VA) origin evaluation, comparing it to computed tomography angiography (CTA) and digital subtraction angiography (DSA).

CEUS was performed by an expert sonographer and images were compared to CTA and/or DSA. For each patient, all procedures were completed within a 5-d interval. This retrospective study analyzed data collected in a prospectively maintained database between September 2022 and December 2024. Parameters such as the VA origin diameter and VA length were analyzed. Patient characteristics were considered for subgroup analysis.

Sixty patients underwent VA origin assessment with CEUS, of which 59 (98.3%) underwent CTA and 39 (65.0%) had DSA performed. The VA origin was successfully identified in 96.7% of patients on CEUS, with two patients showing anatomic variation. The mean diameters of the left and right VA origins were 4.3 ± 1.1 mm and 3.9 ± 1.2 mm, respectively, which were comparable to CTA (4.2 ± 0.9 mm and 3.8 ± 1.1 mm) and DSA (4.3 ± 1.2 mm and 3.9 ± 1.3 mm) with no significant differences (p > 0.05). CEUS also demonstrated intraplaque neovascularization and blood flow direction, whereas CTA and DSA could only identify plaques as filling defects. The mean arrival time (AT) for left and right VAs were 10.6 ± 3.4 s and 10.2 ± 4.4 s, respectively. The mean time to peak (TTP) for left and right VAs were 15.5 ± 11.3 s and 13.3 ± 5.1 s, respectively. Delayed AT and TTP of the VA, compared to the ipsilateral common carotid artery, indicated underlying steal syndrome, which was identified in two patients with >80% stenosis of the left subclavian artery.

CEUS provided comparable results to DSA and CTA for VA origin and V1 segment assessment. Despite its limitations, CEUS effectively distinguishes plaques and abnormalities, making it a promising, non-invasive tool for VA origin evaluation and vertebrobasilar stroke prevention.