Discrepancy Between Duplex Sonography and Digital Subtraction Angiography When Investigating Extra- and Intracranial Ulcerated Plaque

We report two patients who had cerebral ischemic symptoms due to high-grade stenosis of either the cervical internal carotid artery (ICA) or the middle cerebral artery (MCA), combined with an ulcerated plaque. Ultrasonographic Doppler analysis identified high-grade stenotic lesions as marked elevations in the turbulent flow of the cervical ICA in one patient and of the middle cerebral artery in the other patient. Subsequently, huge plaque ulceration was found by color B-mode scanning of the patient with cervical ICA stenosis. However, DSA was able to demonstrate only a mild–moderate degree of stenosis associated with the lesions. High-grade stenotic lesions of the ICA and the middle cerebral artery were reconfirmed by computed tomography angiography and magnetic resonance angiography. An atheromatous plaque with ulceration is believed to be the cause of this discrepancy between ultrasonography and DSA.
Source: Journal of Medical Ultrasound - Category: Radiology Source Type: research