Comparison of Contrast-Enhanced Ultrasonography to Color Doppler Ultrasound in Evaluation of Carotid Body Tumors

Figures

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  Figure 1. Representative CTA images of CBT. The figure shows the representative CTA images of a Shamblin type I CBT in axial view (A) and coronal view (B). CTA images of a Shamblin type III CBT were shown in axial view (C) and coronal view (D). The tumor lesions displayed typical radiographic characteristics of CBTs with localization at carotid bifurcation, splaying of carotid arteries, and hypervascularity. No encasement and complete encasement to ICA or ECA were noticed in Shamblin I (A, B) and Shamblin III lesions (C, D), respectively. CBT, carotid body tumor; CTA, computed tomography angiography; ICA, internal carotid artery; ECA, external carotid artery.

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  Figure 2. Contrast enhancement in CBT lesion area. (A) Contrast enhancement was firstly observed in carotid arteries, (B) followed by the enhancement of tumor feeding vessels deriving from ECA and ICA (thin arrows) 10 s after the injection of the contrast agent. (C) The contrast agents then diffused rapidly from feeding vessels and exhibited progressing enhancement in the solid area. (D) The signal intensity decreased within the carotid arteries and solid area of the tumor, and the enhancement could be observed in the jugular veins. CBT, carotid body tumor; ICA, internal carotid artery; ECA, external carotid artery.

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  Figure 3. TIC analysis of CBT lesions with heterogeneous and homogeneous enhancement. (A) TIC analysis revealed a heterogeneously enhanced lesion. The lesion showed a fast wash-in, slow wash-out, with high peak intensity enhancement pattern. (B) A homogeneous enhancement lesion area. CBT, carotid body tumor; TIC, time–intensity curve.

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  Figure 4. CEUS is superior to assess the morphology of CBT lesions in comparison to gray-scale ultrasound. (A) CBT lesions presented as oval-shaped and hypoechoic masses, which led to splaying of the carotid bifurcation. The adventitia of carotid vessels could be observed clearly on gray-scale ultrasound (thin arrow). (B) However, the adventitia (thin arrow) could hardly be visualized in CEUS during the artery phase. (C) A very small part of ICA was encased by the lesion area. The margin (triangles) of the tumor around ECA could not be seen clearly, and a Shamblin type II was identified using grey-scale ultrasound. (D) The margin of the tumor (triangles) could be better observed using CEUS and a Shamblin type III was reclassified. CBT, carotid body tumor; CEUS, contrast-enhanced ultrasonography; ICA, internal carotid artery; ECA, external carotid artery.

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  Figure 5. Vascularity and feeding vessels of CBT lesions. (A) CDU showed a hypervascularity and hypoechoic mass located at carotid bifurcation, and (B) robust signal intensity could be seen 1–2 s after the enhancement of carotid arteries on CEUS. (C) Feeding vessels (thin arrows) of another CBT lesion could be observed deriving from both ECA and ICA on CDU and (D) on CEUS. CBT, carotid body tumor; CEUS, contrast-enhanced ultrasonography; CDU, color Doppler ultrasound; ICA, internal carotid artery; ECA, external carotid artery.