Imaging of aortic lesions with color coded duplex sonography and contrast-enhanced ultrasound versus multislice computed tomography (MS-CT) angiography

Purpose: The purpose of this study was to compare color coded duplex sonography (CCDS), contrast-enhanced ultrasound (CEUS) and multislice computed tomography (MS-CT) angiography in pathological aortic lesions. Material and methods: 36 patients with a mean age of 71 years (range 51-87 yrs) with known or suspected treated and untreated aortic lesions detected by CTA were included in this prospective study. Standardized MS-CTA using a 16 or 64 row scanner (Somatom Sensation 16 or 64, Siemens Medical Systems, Forchheim, Germany) served as reference standard. The patients were examined with CCDS and CEUS (Logiq 9, General Electrics, Milwaukee, WI) using the low MI technique with intravenous injection of 1.6-2.4 ml SonoVue (Bracco, Italy). Contrast enhanced ultrasound was performed in the arterial, venous and late venous phase. Results: In all patients CEUS resulted in a relevant diagnosis of an aortic pathology. In total, two covered ruptures, nine aortic dissections and five aortic aneurysms were detected. In the routine follow-up of 20 patients following endovascular repair (EVAR) of abdominal aortic aneurysm (AAA), one type 3 and three type 2 endoleaks after y-stent graft were detected. For presurgical planning, in addition to the perfused true and false lumen after dissection the perfusion of the renal arteries was examined. Conclusion: CEUS with SonoVue allows the evaluation of aortic lesions. It is an additional examination to CTA. It may allow a more rapid and noninvasive diagnosis, especially in critical patients from intensive care units because of its bedside availability. As the examination is dynamic, additional information about blood flow in the true and false lumen and about renal perfusion after dissections can be evaluated. Especially in patients with contraindications to CT contrast agents (e. g. due to renal failure or severe allergy), CEUS provides a good alternative to MS-CT.