Neuromuscular ultrasound is one of the fastest growing areas. Due to the close anatomical relationship, vascular sonographers should have seen nerve structures during their routine studies. In this review, brief technical comments are provided for “novice” neuromuscular sonographers, in order to depict major peripheral nerves. Furthermore, images show characteristic sonographic changes in various neuromuscular diseases.
Dural arteriovenous fistula was examined by carotid ultrasonography (CUS) in five patients with cavernous sinus dural arteriovenous fistula (CS-dAVF) and 14 patients with transverse sigmoid sinus dural arteriovenous fistula (TS-dAVF). All 19 patients were diagnosed using digital subtraction angiography. CUS parameters, including the end-diastolic ratio of the common carotid artery (CCA-ED ratio), end-diastolic flow velocity of the external carotid artery (ECA EDV), and the resistance index of the external carotid artery (ECA RI), were examined before and after treatment of CS-dAVF and TS-dAVF. A comparison of the CUS parameters before treatment showed increases in the CCA-ED ratio and ECA EDV and a decrease in the ECA RI in TS-dAVF patients. After treatment, the difference in the changes in TS-dAVF vs. CS-dAVF patients was significant. Thus, compared with before treatment, the CCA-ED ratio (pre: 1.80 vs. post: 1.38, p = 0.005) and ECA EDV (cm/s) (54.4 vs. 29.9, p = 0.001) decreased significantly in TS-dAVF patients, whereas the ECA RI was significantly higher in both TS-dAVF (0.60 vs. 0.72, p = 0.005) and CS-dAVF (0.76 vs. 0.85, p = 0.043) patients. These results demonstrated the utility of CUS in estimating the therapeutic effect of dAVF, especially in patients with TS-dAVF.
Purpose: Carotid ultrasonography and ankle-brachial pressure index (ABI)/brachial-ankle pulse wave velocity (baPWV) tests are useful for evaluating systemic vessels, but their contribution to the diagnosis of stroke subtypes is unknown. Methods: We included consecutive 183 patients of brain infarction on which both carotid ultrasonography and ABI/baPWV was performed from July 2014 to June 2015. We evaluated the mean/max intima-media thickness (IMT), plaque score, LDL cholesterol, HDL cholesterol, D-dimer, NT-proBNP, eGFR, HbA1c, and ABI/baPWV. In ABI, we used the lower side of the ankle and divided into two groups: ABI
< 0.9 and ABI ≥ 0.9. In baPWV, we used the higher side and divided into two groups: baPWV > 1,983cm/s and baPWV ≤ 1,983cm/s. Results: Among the 99 patients diagnosed with cardioembolic infarction, atherothrombotic infarction, or lacunar infarction, neither carotid ultrasonography nor ABI/baPWV was associated with stroke subtypes. However, among the 84 patients diagnosed with an unclassified or other etiology, 9 were diagnosed with aortogenic cerebral embolism. A multivariate analysis showed that aortogenic cerebral embolism was significantly associated with the mean IMT and ABI. Conclusion: Among unclassified or other etiology stroke patients, mean IMT and ABI are suggested for the diagnosis of aortogenic cerebral embolism.
Purpose: To understand the wall movement of the carotid artery (CA) is crucial for evaluating mobile plaques with Jellyfish sign. The authors hypothesized that CA may move not only vertically to vessel wall synchronized with pulsation but also parallel by the CA itself. The aim of this study is to analyze the movement of the CA. Methods: Thirty patients with CA stenosis were investigated between November 2016 and January 2017. The region of interest (ROI) was settled in plaques of common CA (CCA) and internal CA (ICA) wall. The total movement of ROIs of CCA and ICA was measured by the template matching technique (free software by Intel Corporation). Results: Overall 47 vessels with 104 lesions (CCA: 76, ICA: 28) were evaluated. The ROIs of the CCA and ICA moved not only a vertically but also parallel to vessel wall. Furthermore, the movement of ROIs of the CCA was found to be larger than that of ICA (6.3 ± 0.4 mm vs. 4.6 ± 0.4 mm, p = 0.016). Conclusion: The carotid artery moves vertically and in cranio-caudal direction as well.
A 79-year-old woman was admitted to our hospital with vertigo. Vertigo was exacerbated by head rotation. Head magnetic resonance imaging revealed no acute cerebral infarction. The bilateral posterior communicating artery was not seen on magnetic resonance angiography. Three-dimensional computed tomographic angiography revealed severe stenosis in the left subclavian artery. Carotid Doppler ultrasonography (CDUS) revealed a change in the vertebral artery (VA) blood flow with the head rotated. These findings were also confirmed using dynamic digital subtraction angiography (DSA). Stenting in the left subclavian artery was performed, and the vertigo disappeared. This is the first report of subclavian steal syndrome that appeared with head rotation. These findings suggest that evaluation of VA and subclavian artery using dynamic CDUS and DSA is required for patients presenting with vertebrobasilar insufficiency even if VA blood flow is antegrade in the neutral position.