+ All Categories
Home > Documents > CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound...

CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound...

Date post: 21-Jan-2016
Category:
Upload: imogene-griffith
View: 272 times
Download: 9 times
Share this document with a friend
Popular Tags:
99
CAROTID DUPLEX ULTRASOUND • Jenelle (General Ultrasound Department) • Anatomy • Normal Carotid Ultrasound • Todd (Vascular Ultrasound Department-Coordinator) • Abnormal Carotid Ultrasound • Live Scanning • Demonstration by Todd • Practice time – grab a partner!
Transcript
Page 1: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

CAROTID DUPLEX ULTRASOUND

• Jenelle (General Ultrasound Department)• Anatomy• Normal Carotid Ultrasound

• Todd (Vascular Ultrasound Department-Coordinator)• Abnormal Carotid Ultrasound

• Live Scanning• Demonstration by Todd• Practice time – grab a partner!

Page 2: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

CAROTID DUPLEX ULTRASOUNDJenelle Beadle

March, 2015

Page 3: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

OBJECTIVES

• Anatomy• Classic• Variants

• Carotid Duplex Ultrasound• Indications• Position/Technique• Required Images• Normal spectral analysis

• Tips/Pitfalls

Page 4: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

ANATOMY

Page 5: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Cerebrovascular System• supplies the head

Carotid Duplex Ultrasound• exams the extracranial

portion of the cerebrovascular system

Page 6: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Extracranial Cerebrovascular System• Innominate/brachiocephalic• Subclavian• Vertebral• Common Carotid (CCA)• Internal Carotid (ICA)• External Carotid (ECA)

http://www.slideshare.net/shaffar75/doppler-ultrasound-of-carotid-arteries

Page 7: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Innominate/brachiocephalic(Rt sided only)• Originate: Aortic Arch (1st)• Terminate: Rt CCA / Rt

Subclavian

Page 8: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Subclavian Arteries• Originate:

• Rt – Innominate• Lt – Aortic Arch (3rd)

• Branches: Vertebral• Terminate: Axillary

Page 9: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Vertebral Arteries• Originate: Subclavian

Page 10: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Vertebral Arteries• Originate: Subclavian• Pass through transverse

foramena• C6• Atlas (C1)

• Terminate: join to form basilar (intracranial)

Page 11: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Common Carotid Arteries (CCA)• Originate:

• Rt – Innominate• Lt – Aortic Arch (2nd)

• Terminate: ICA/ECA

Page 12: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

External Carotid Arteries (ECA)• Originate: CCA

Page 13: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

External Carotid Arteries (ECA)• Branches: numerous

• 1st: Superior Thyroid• Terminate: Superficial Temporal / Maxillary

Page 14: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Internal Carotid Arteries (ICA)• Originate: CCA

Page 15: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

• NO extracranial branches

Page 16: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Internal Carotid Arteries (ICA)

• Originate: CCA• Branches:

• Intracranial only

Page 17: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Internal Carotid Arteries (ICA)

• Originate: CCA• Branches:

• Intracranial only

• Terminate: • Circle of Willis

Page 18: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.
Page 19: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.
Page 20: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.
Page 21: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Innominate/Brachiocephalic

Page 22: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Innominate/Brachiocephalic

Rt Subclavian

Page 23: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Innominate/Brachiocephalic

Rt Subclavian

Rt Vertebral

Page 24: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Innominate/Brachiocephalic

Rt Subclavian

Rt Vertebral

Rt CCA

Page 25: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Innominate/Brachiocephalic

Rt Subclavian

Rt Vertebral

Rt CCA

Rt ICA

Page 26: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Innominate/Brachiocephalic

Rt Subclavian

Rt Vertebral

Rt CCA

Rt ICA

Lt Vertebral

Page 27: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Innominate/Brachiocephalic

Rt Subclavian

Rt Vertebral

Rt CCA

Rt ICA

Lt Vertebral

Lt ICA

Page 28: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Innominate/Brachiocephalic

Rt Subclavian

Rt Vertebral

Rt CCA

Rt ICA

Lt Vertebral

Lt ICA

Lt ECA

Page 29: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Innominate/Brachiocephalic

Rt Subclavian

Rt Vertebral

Rt CCA

Rt ICA

Lt Vertebral

Lt ICA

Lt ECA

Lt CCA

Page 30: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Innominate/Brachiocephalic

Rt Subclavian

Rt Vertebral

Rt CCA

Rt ICA

Lt Vertebral

Lt ICA

Lt ECA

Lt CCA

Lt Subclavian

Page 31: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Innominate/Brachiocephalic

Rt Subclavian

Rt Vertebral

Rt CCA

Rt ICA

Lt Vertebral

Lt ICA

Lt ECA

Lt CCA

Lt Subclavian

Aortic Arch

Page 32: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

ANATOMICAL VARIANTS

Page 33: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Numerous anatomical variants involving the aortic arch branches

Page 34: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

VARIANTS• Bovine Arch (10%)• Left vertebral arises

from aortic arch (3%)• Aberrant right

subclavian artery (2%)

CLASSIC (85%)• 3 Branches:

Innominate, Lt CCA, Lt Subclavian

*All other aortic arch variants combined (<1%)

Classic 85% Bovine 10%

Aberrant Rt SCl 2%

Lt Vert 3%

Page 35: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

BOVINE ARCH (10%)

Bovine Arch: common origin for Innominate and Left CCA

Normal: 3 separate aortic arch branches

• Most common aortic arch branching variant

Page 36: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

BOVINE ARCH (10%)

Bovine Arch: common origin for Innominate and Left CCA

• Most common aortic arch branching variant

Page 37: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Normal: 3 separate aortic arch branches

Bovine Arch: Left CCA originates from Innominate

BOVINE ARCH• Type 2

Page 38: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

“BOVINE” ARCH

Misnomer:• Erroneous reference to

cow’s anatomy• Actual cow anatomy

consists of a single trunk branch off the aortic arch

Page 39: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

LEFT VERTEBRAL – 3RD BRANCH(3%)• Left vertebral: 3rd branch

• Left subclavian: 4th branch

Page 40: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

ABERRANT RIGHT SUBCLAVIAN (2%)• Right subclavian: 4th branch

• Right CCA: 1st branch• No innominate

Page 41: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

ICA TORTUOSITY VARIANTS• Course variations are common

http://www.slideshare.net/shaffar75/doppler-ultrasound-of-carotid-arteries

Page 42: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

ICA TORTUOSITY VARIANTS• Course variations are common

http://www.slideshare.net/shaffar75/doppler-ultrasound-of-carotid-arteries

Page 43: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

ICA/ECA ORIGIN VARIANTS• Variations in origin of the

ECA & ICA are uncommon

Page 44: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

• C6 (93%) – most common• C5 (5%) – 2nd most

common

VERTEBRAL ARTERY COURSE VARIANTS

Page 45: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

CAROTID DUPLEX ULTRASOUND

Page 46: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

INDICATIONS

• Cerebrovascular Accident (CVA)• Transient Ischemic Attacks (TIA)• Cervical Bruit• Pulsatile Mass• Less Specific Symptoms• Dizziness• Headaches

• Pre-operative• Post-operative• Monitor known carotid arterial disease

Page 47: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

POSITION/TECHNIQUE

Patient Position

• Supine

• Head angled to the side

• Rolled towel under neck

• Position adjusted to optimize sonographic window

Page 48: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

POSITION/TECHNIQUE

Patient Position

• Supine

• Head angled to the side

• Rolled towel under neck

• Position adjusted to optimize sonographic window

Technique

• Highest frequency, penetrating transducer

• Keep angle at 60 degrees• Diagnostic Criteria• Reproducibility

• 3-5 cycles/waveform

• Waveform 2/3 of image• Lower baseline• Decrease scale

Page 49: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

EXAM PROTOCOL• Protocol will be available on Sharepoint

• Written and Image formats• Protocol still needs to be approved to be made

official

Page 50: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

EXAM PROTOCOL• Protocol will be available on Sharepoint

• Written and Image formats• Protocol still needs to be approved to be made

official• Scan Assistant protocol has been set up in

accordance with written protocol• Protocol will also be set up on Siemens

machine at SH

Page 51: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

EXAM PROTOCOL• Protocol will be available on Sharepoint

• Written and Image formats• Protocol still needs to be approved to be made

official• Scan Assistant protocol has been set up in

accordance with written protocol• Protocol will also be set up on Siemens

machine at SH• Examine all accessible portions of the CCA/ICA

• Basic assessment of the ECA/Vert/Subcl

Page 52: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

EXAM PROTOCOL• Protocol will be available on Sharepoint

• Written and Image formats• Protocol still needs to be approved to be made

official• Scan Assistant protocol has been set up in

accordance with written protocol• Protocol will also be set up on Siemens

machine at SH• Examine all accessible portions of the CCA/ICA

• Basic assessment of the ECA/Vert/Subcl• Protocol is designed to be the minimal required

images• Additional images will often be necessary when

the exam is normal• Additional images will always be necessary

when pathology is encountered

Page 53: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

CCA Proximal• Trans

*Image at the most proximal, straight segment

Page 54: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

CCA Proximal• Long

Page 55: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

CCA Proximal• Color Doppler

Page 56: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

CCA Proximal• Spectral Doppler

Page 57: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

CCA Distal• Trans

*2-3cm below the bifurcation

Page 58: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

CCA Distal• Long

Page 59: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

CCA Distal• Color Doppler

Page 60: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

CCA Distal• Spectral Doppler

Page 61: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

CCA Spectral Analysis:• EDV should be above zero• EDV should be similar to the contralateral CCA, taken at

approximately the same level

Page 62: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Bifurcation• Trans (bulb)

Page 63: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Bifurcation• Trans (just

above bulb)

Page 64: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

ECA Prox• Long

*Look for branches

Page 65: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

ECA Prox• Color Doppler

Page 66: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

ECA Prox• Spectral Doppler

Page 67: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

ECA Spectral Analysis• Higher resistance than the ICA • PSV normally greater ICA• Sharp upstroke• Prominent dicrotic notch (may reverse)• EDV approach/reach zero

Page 68: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

*Include bulb

ICA Prox• Long

Page 69: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

ICA Prox• Color Doppler

*Obtained just below the bulb where vessel is no longer dilated

Page 70: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

ICA Prox• Spectral Doppler

*Waveform may reflect flow disturbances of the bulb extending into the prox ICA

Page 71: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

ICA Mid• Color Doppler

Page 72: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

ICA Mid• Spectral Doppler

Page 73: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

ICA Dist• Color Doppler

Page 74: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

ICA Dist• Spectral

Doppler

Page 75: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

ICA Spectral Analysis• Low resistance• Continuous forward flow• EDV well above zero

Page 76: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Vertebral• Color Doppler

Page 77: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Vertebral• Spectral

Doppler

Page 78: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Vertebral Spectral Analysis• Low resistance• Slightly more resistive than the ICA

• Antegrade, bidirectional, retrograde

Page 79: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Subclavian• Color Doppler

*Sampled close to the origin

Origin

Page 80: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Subclavian• Spectral Doppler

Page 81: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Subclavian Spectral Analysis• High resistance• Reversal late systole/early diastole

Page 82: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

REPEAT ON LEFT

Page 83: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

ONLINE FORM

PSV EDV

PSV

Page 84: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

TIPS/TRICKS

Page 85: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Long ECA/ICA• Two for the

price of one

Page 86: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Long ECA/ICA• Two for the

price of one

Page 87: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Branches = ECA

Page 88: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Temporal Tap• Tap on superficial temporal artery • ant/sup to ear

• Indicates ECA• Not reliable http://www.slideshare.net/shaffar75/doppler-ultrasound-of-carotid-arteries

Page 89: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

http://www.slideshare.net/shaffar75/doppler-ultrasound-of-carotid-arteries

Page 90: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Bulb• “ICA Prox”• Widened portion of the proximal ICA• Disturbed flow• Unidirectional along the flow divider of the birfurcation• Zero/reversed flow at outer wall

Page 91: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Vertebral Origin• Most common

location for stenoses

Page 92: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Innominate• Not required

unless pathology is suspected

CCA

Subclav

Page 93: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Innominate• Not required

unless pathology is suspected

Page 94: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

• Distal ICA• can be difficult to

demonstrate

• Prox/Mid ICA Doppler settings are not adequate to optimize the distal ICA• adjustments must be

made

IMAGE QUALITY

Page 95: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Lowered Color Frequency

Page 96: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Increase Color Gain

Page 97: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

Decreased Steer Box Angle

Page 98: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

BeforeAfter

Page 99: CAROTID DUPLEX ULTRASOUND Jenelle (General Ultrasound Department) Anatomy Normal Carotid Ultrasound Todd (Vascular Ultrasound Department-Coordinator) Abnormal.

THE END


Recommended