Diagnostic value of vascular ultrasonography in cervical carotid artery dissection

Objective：To investigate the imaging features and diagnostic value of vascular ultrasonography in cervical artery dissection (CAD). Methods：32 patients suspected of CAD were selected from Janaury 2016 to March 2017 in Subei People’s Hospital of Jiangsu Province. All patients detected by ultrasonography, high-resolution magnetic resonance imaging (HR-MRI) and (or) digital subtraction angiography. According to the results of HR-MRI and (or) DSA, the sensitivity, specificity and accuracy of vascular ultrasonography in CAD patients were determined. Results：19 patients with a total of 23 dissections (18 internal carotid arteries and 5 vertebral arteries) were confirmed. The direct ultrasound signs of CAD consisted of intramural hematoma(14), double lumens(5), aneurysmal dilatation(3), and intimal flap(1)．Indirect ultrasound signs of CAD included stenosis/occlusion in a segment usually not affected by atherosclerosis, increased or decreased pulsatility upstream or downstream to the suspected arterial lesion, >50% difference in the blood flow velocity compared to the same segment of the artery on the unaffected side. Compared with HR-MRI and (or) DSA, the sensitivity of ultrasonography for CAD was 91.3%, the specificity was 89.5%, the accuracy was 90.5%. The ROC analysis showed the area under the curve was 0.904. There was a high level of agreement between ultrasonography and HR MRI (Kappa=0.808). Conclusions：Vascular ultrasonography can diagnose CAD effectively. It has the advantage of minimally invasive, and is useful to clinical practice.