Color Doppler ultrasonography findings of vertebral arteries: A correlation with 64-slice CTA

Year 2021, Volume: 5 Issue: 7, 705 - 709, 01.07.2021

Behice Kaniye Yılmaz , Elif Ergün , Pınar Nercis Koşar , Betül Şimşek Karataş , Ahmet Tuncay Turgut

https://doi.org/10.28982/josam.935324

Abstract

Background/Aim: Although normal Color Doppler US (CDU) findings of the carotid system were described by many studies, normal findings of the vertebral system have not been studied extensively. This study aimed to evaluate vertebral artery CDU hemodynamic and morphologic findings in patients with normal vertebral arteries (VAs) on 64-slice Computed Tomography Angiography (CTA) and investigate the correlation between RDUS and CTA in evaluating the VA anatomy.
Methods: In this retrospective cohort analysis, the patients referred to our radiology department for CTA who had normal VA anatomy underwent a CDU for visualization of the orifice and segments (V1-V2) of the VA. Peak systolic velocity (PSV), and end-diastolic velocity (EDV) were measured in V1 while PSV, EDV were measured and resistive index and FV were calculated in V2. The presence of hypoplasia and dominance were noted.
Results: A total of 77 patients who had normal vertebral arteries on CTA were included in this study. CDU findings were highly consistent with multislice CTA findings regarding the measurement of VA diameter (ICC=0.856, ICC=0.830), hypoplasia (kappa=0.488), and dominance (kappa=0.752). No consistency was found between the two modalities in the visualization of the orifice and V1 segment of the VAs on both sides. CTA was able to show the orifice and the V1 segment in all cases, while the success rate was lower in CDU, especially in terms of visualizing the orifice of VA. VA FV was not significantly different between the patients with and without vertebrobasilar insufficiency (P=0.300).
Conclusion: CDU findings were consistent with 64-slice CTA findings in VA diameter measurement and the diagnosis of hypoplasia and dominance. However, CTA is more successful than RDUS in evaluating the vertebral artery orifice and V1 segment, the most common sites of atherosclerotic involvement. There was no significant difference between the patients with and without VBI symptoms in evaluating FV.

Keywords

Vertebral artery, Doppler ultrasound, Computed tomography angiography, Vertebrobasilar insufficiency

References

• 1. Hallerstam S, Rosfors S. Blood flow and resistance in the vertebral arteries of the patients with and without carotid atherosclerosis. Clin Physiol Funct Imaging. 2004;24:96-102.
• 2. Kızılkılıç O, Hurcan C. Color Doppler Analysis of Vertebral Arteries Correlative study with Angiographic Data. J Ultrasound Med. 2004;23:1483-91.
• 3. Hankey GJ, Warlow CP, Sellar RJ. Cerebral angiographic risk in mild cerebrovascular disease. Stroke. 1990;21:209-22.
• 4. Waug JR, Sacharias N. Arteriographic complications in the DSA era. Radiology. 1992;182:243-6.
• 5. Cloft HJ, Joseph GJ, Dion JE. Risk of cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation: a meta-analysis. Stroke. 1999;30:317-20.
• 6. Kafadar S, Aydın A. Vertebrobaziller yetmezlik semptomları olan hastalarda vertebral arterin dupleks Doppler us yöntemiyle değerlendirilmesi. Uludağ Üniversitesi Tıp Fakültesi Dergisi. 2002;28:95-9.
• 7. Bendszus M, Koltzenburg M, Burger R. Silent embolism in diagnostic cerebral angiography and neurointerventional procedures: a prospective study. Lancet.1999; 354:1594-7.
• 8. Buckenham TM, Wright A. Ultrasound of the extracranial vertebral artery. Br J Radiol. 2004;77:15-20.
• 9. Farres MT, Grabenwoger F, Magometschnig H. Spiral CT angiography: study of stenoses and calcification at the origin of the vertebral artery. Neuroradiology. 1996; 38:738-43.
• 10. Bendick PJ, GloverJL. Vertebrobasilar insuffciency: Evaluation by quantitative duplex flow measurements: A preliminary report. J Vase Surg. 1987;5:594-600.
• 11. Kikuchi S, Higo R. Deafness associated with vertebrobasilar insufficiency. Journal of the Neurological Sciences. 2001;187:69–75
• 12. Sidhu PS. Ultrasound of the carotid and vertebral arteries. Br Med Bull. 2000; 56:346-66.
• 13. Yazıcı B, Erdoğmuş B, Tugay A. Sağlıklı erişkinlerde serebral kan akımının karotid ve vertebral arter Doppler ultrasonografi yoluyla ölçülmesi. Diagn interv radiol. 2005;11:195-8.
• 14. Horrow MM, Stassi J. Sonography of the vertebral arteries: a window to disease of the proximal great vessels. Am J Roentgenol. 2001;177:53-9.
• 15. Landwehr P, Schulte O, Voshage G. Ultrasound examination of carotid and vertebral arteries. Eur Radiol. 2001;11:1521-34.
• 16. Puchner S, Haumer M. CTA in the detection and quantification of vertebral artery pathologies: a correlation with color Doppler sonography. Neuroradiology. 2007;49:645-50.
• 17. Zweibel JW, Pellerito JS. Vasküler Ultrasona Giriş. İstanbul: İstanbul medical yayıncılık; 2006
• 18. Bendick PJ, Glover JL. Hemodynamic evaluation vertebral arteries by duplex ultrasound. Surg Clin North Med. 1990;70:235-44.
• 19. Lovrencic-Huzjan A, Demarin V, Bosnar M, et al. Color Doppler flow imaging (CDFI) of the vertebral arteries the normal appearance, normal values and proposal for the standards. Coll Antropol. 1999;23:175-81.
• 20. Bartels E, Fuchs HH. Duplex ultrasonography of vertebral arteries: examination, technique, normal values, and clinical applications. Angiology. 1992;43:169-80.
• 21. Touboul PJ, BousseR MG, Laplane D, Castaİone P. Duplex Scanning of Normal Vertebral Arteries. Stroke Vol. 1986;17(5):921-3.
• 22. Yazıcı B, Erdoğmuş B, Tugay A. Measuring of cerebral blood flow in healthy adults by carotid and vertebral artery Doppler ultrasonography. Diagn interv radiol. 2005; 11:195-8.
• 23. Korbicka J. Klassifizierung und Topographie arteriosklerotischer Veranderungen in den einzelnen Segmenten der A. vertebralis alter Menschen. Zentralbl Allg Pathol.1966;109:461-80.
• 24. Vitte E, Feron J M, Guerin-Surville H et al. Anatomical study of digital compression of the vertebral artery at its origin and the suboccipital triangle. Anat Clin. 1985;7:77-82.
• 25. Trattnig S, Hubsch P. Color-Coded Doppler Imaging of Normal Vertebral Arteries. Stroke. 1990;21:1222-5.
• 26. Visona A, Lusani L. The echo-Doppler (dublex) system for the detection of vertebral artery occlusive disease: comparison with angiography. J Ultrasound Med. 1986;5:247-50.
• 27. Uflacker R. Atlas of vascular anatomy. Philadelphia: Lippincott, Williams and Wilkins. 1997;17-18.
• 28. Davis PC, Nilsen B, Braun IF and Hoffman JC. A prospective comparison of duplex sonography vs angiography of the vertebral arteries. AJN. 1986;l7:1059-64.
• 29. Bruneau M, Cornelius JF, Marneffe V. Anatomical Variations of the V2 Segment of the Vertebral Artery. Neurosurgery July. 2006;59:20-4.
• 30. Seidel E, Eieke BM, Tettenborn B, et al. Reference values for vertebral artery flow volume by duplex sonography in young and elderly adults. Stroke. 1999; 30:2692-6.
• 31. Tratting S, Schwaighofer B, Hübsch P. Color-coded Doppler sonography of vertebral arteries. J Ultrasound Med. 1991;10:221-6.
• 32. Scheel P, Ruge C, Schöning M. Flow velocity and flow volume measurements in the extracranial carotid and vertebral arteries in healthy adults: Reference data and the effects of age. Ultrasound Med Biol. 2000;26:1261-6.
• 33. Koch S, Romano J, Park H, Amir Murtaza, Forteza AM. Ultrasound Velocity Criteria for vertebral origin stenosis. J Neuroimaging. 2009;19:242-5.