From the Guidelines
Yes, ultrasound can confirm atherosclerosis, as it can detect plaque buildup in arterial walls, measure intima-media thickness, and assess blood flow restrictions, as supported by the 2012 European guidelines on cardiovascular disease prevention in clinical practice 1.
Key Points
- Vascular ultrasound, particularly carotid ultrasound and intravascular ultrasound (IVUS), is a non-invasive means of assessing subclinical atherosclerosis.
- The test is painless and takes about 30-60 minutes depending on the vessels being examined.
- Ultrasound works by sending sound waves that bounce off tissues and blood vessels, creating images that show the structure of vessel walls and any plaque accumulation.
- While ultrasound is excellent for detecting atherosclerosis in accessible arteries like the carotid, femoral, and peripheral vessels, it has limitations in visualizing deeper arteries such as the coronary arteries, where other imaging techniques like coronary CT angiography might be more appropriate.
Indications for Carotid Duplex Sonography
- Cervical bruit in an asymptomatic patient
- Follow-up of known stenosis (>50%) in asymptomatic individuals
- Vascular assessment in a patient with multiple risk factors for atherosclerosis
- Stroke risk assessment in a patient with CAD or PAD
- Amaurosis fugax
- Hemispheric TIA
- Stroke in a candidate for carotid revascularization
- Follow-up after a carotid revascularization procedure
- Intraoperative assessment during CEA or stenting
Important Considerations
- The severity of stenosis is defined according to angiographic criteria, but it corresponds as well to assessment by sonography and other accepted methods of measurement such as CTA and MRA, although the latter may overestimate the severity of stenosis 1.
- Accurate assessment of the severity of arterial stenosis is essential to the selection of appropriate patients for surgical or endovascular intervention, and imaging of the extracranial carotid arteries should be performed whenever cerebral ischemia is a suspected mechanism of neurological symptoms in a viable patient.
From the Research
Ultrasound Diagnosis of Atherosclerosis
- Ultrasound can be used to confirm atherosclerosis, with studies suggesting its effectiveness in evaluating peripheral atherosclerosis and coronary artery disease 2, 3.
- The staging of subclinical atherosclerosis through ultrasound may help in further clinical decisions, and its use is emphasized in the latest ESC guidelines for the diagnosis of coronary artery disease and subclinical assessment of atherosclerosis 2.
- Ultrasound examination of peripheral arteries, such as the femoral arteries, is relatively easy, quick, and accurate, while other vascular beds like iliac and renal arteries can also provide valuable information 2.
Ultrasound Methods for Atherosclerosis Evaluation
- Conventional ultrasound methods, including B-mode US and Doppler mode, can provide a rapid and cost-efficient way to visualize established plaques and give a rapid risk stratification of the patient 3.
- Measurement of carotid intima-media thickness (C-IMT) may be useful in identifying subclinical atherosclerosis, although its use is somewhat disputed 3.
- Contrast-enhanced ultrasonography (CEUS) and newly emerging elastography techniques, such as strain elastography and shear-wave elastography, can add new dimensions to the evaluation of atherosclerosis 3, 4.
Comparison with Other Imaging Modalities
- Ultrasound is one of several imaging modalities available for the assessment of atherosclerotic burden, including computed tomography, magnetic resonance imaging (MRI), positron emission tomography (PET), and interventional angiography 5.
- Each imaging technique has its strengths and weaknesses, and a detailed understanding of the risks and benefits of each technique is crucial prior to their introduction into routine cardiovascular screening 4, 5.