Key result
SMI-TOCU provides clear internal carotid artery imaging comparable to contrast-enhanced TOCU.
Why the study?
Conventional carotid artery ultrasonography cannot produce clear intraluminal images of extracranial ICA lesions, and the similarity between CETOCU and TOCU with SMI needed examination.
Does TOCU with SMI provide comparable image quality to CETOCU for evaluating extracranial internal carotid artery lesions?
Case Report (n=3)
No
Does TOCU with SMI provide comparable image quality to CETOCU for evaluating extracranial internal carotid artery lesions?
Transoral carotid ultrasonography with superb microvascular imaging provides clear intraluminal images of the extracranial internal carotid artery similar to contrast-enhanced ultrasound, offering a non-invasive alternative without contrast agents.
SMI-TOCU may offer a contrast-free carotid imaging option; single case report leaves open need for prospective validation.
Transoral carotid ultrasonography (TOCU) is a powerful tool for evaluating ICA lesions located from carotid bifurcation to the second cervical vertebra. In recent case reports, contrast-enhanced transoral carotid ultrasonography (CETOCU), which is essentially TOCU performed with perfluorobutane microbubbles as the ultrasonography contrast agent, produces clear intraluminal image of extracranial ICA, which is not possible with conventional carotid artery ultrasonography (CUS). Superb microvascular imaging (SMI) is a new Doppler imaging technique that employs a unique algorithm to minimize motion artifacts by eliminating clutter signals based on analysis of tissue movement. SMI significantly reduces motion artifacts and allows visualization of low-velocity blood flow in vessels. CUS with SMI and contrast enhanced carotid ultrasound are similar in images, and evaluate plaque neovascularization. We performed TOCU with SMI to two healthy persons, in order to examine similarity between CETOCU and TOCU with SMI. Although there were some inadequacies for small lesions, we found that TOCU with SMI can obtain images similar to CETOCU. TOCU with SMI is expected to be applied to clinical use.
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Hagiwara et al. (2018) conducted a case report in Internal carotid artery stenosis (n=3). Transoral carotid ultrasonography with superb microvascular imaging (SMI-TOCU) vs. Contrast-enhanced transoral carotid ultrasonography (CETOCU) was evaluated on Image similarity and visualization of intraluminal lesions. Transoral carotid ultrasonography with superb microvascular imaging (SMI-TOCU) obtained clear intraluminal images of the extracranial internal carotid artery similar to contrast-enhanced TOCU.
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