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Fig. 18.3 Abdominal aorta after endovascular aortic
aneurysm repair complicated with type II endoleak. The
arterial phase transverse CEUS image. The lumbar artery
is detected posteriorly to the stent-graft (type II endoleak).
Perfused iliac segments of the stent-graft are also observed
Fig. 18.4 Abdominal aorta after endovascular aortic
aneurysm repair complicated with type II endoleak from
the inferior mesenteric artery. Transverse CEUS image.
(a) The early arterial phase. Contrast enhancement of the
peripheral aspects of the aortic aneurysm sac ventrally
from the perfused stent-graft. (b) Gradual enhancement
aortic aneurysm sac in the late arterial phase
CEUS is also feasible to follow up the patients
after various endovascular interventions, such as
stenting the iliac arteries. It is capable to detect
the complications when the imaging conditions
are too poor for the conventional US with Doppler
imaging and other imaging modalities are not
applicable (Fig.18.5).
One useful CEUS feature is the reliable differentiation of retroperitoneal cystic lesions from
blood vessels (Fig.18.6).
318
M. G. Tukhbatullin et al.
a
b
Fig. 18.5 The thrombosis of the stent in the aneurysm of
the external iliac artery. The arterial phase CEUS images.
(a) The aneurysm of the external iliac artery with nonocclusive thrombus and a partially occluded stent. The stent
has an enhancement defect (arrow), the enhanced blood
bypasses the occluded segment of the stent via the aneurysm sac. Scan along the iliac vessels. (b) The aneurysm
sac with concentric thrombus and the enhanced central
aspects. Occluded stent (arrow). Transverse image
18 Major Blood Vessels
319
a
b
c
Fig. 18.6 The cyst of the retroperitoneal space. (a)
Grayscale sonography. The anechoic lesion with clear
smooth boundaries is detected adjacent to the abdominal
aorta (arrow). (b). CEUS image, the arterial phase. The
Visceral artery aneurysms are rare entities.
One example is the gastroduodenal artery aneurism, which accounts for 3.5% of all aneurysms
of visceral arteries [9]. False aneurysms are different from true ones and may result from trauma
and other causes. However, some of them typically arise in patients with chronic pancreatitis.
Chronic pancreatitis often develops cysts, which
cannot resolve by themselves. Large-sized
(>5cm) pancreatic cyst compresses the surrounding structures and if affects the adjacent artery
results in periarterial inammation, necrosis of
the wall, and the development of the stula
between the artery and cystic lumen [9–12]
(Fig.18.7).
lesion is nonenhanced (arrow). (c) CE-CT identies a
nonenhancing retroperitoneal lesion of uid density
(arrow)
Aneurysm of the internal carotid artery along
with atherosclerotic plaques may cause a transient ischemic attack or acute ischemic stroke.
The extracranial carotid artery aneurysm is quite
rare and accounts for 1–2% of all abnormalities
[13] (Fig.18.8).
Atherosclerotic lesions of the carotid arteries
are currently widely diagnosed with Doppler
sonography. It precisely determines the degree
and length of the stenosis, structure of atherosclerotic plaque, and the condition of its surface. The
data obtained with duplex scanning comprise the
basis for the classication of atherosclerotic
plaques, which pays special attention to the signs
of instability. High-grade stenosis and certain
320
M. G. Tukhbatullin et al.
a
b
Fig. 18.7 A false aneurysm of the gastroduodenal artery
in the pancreatic head cyst. The status after stenting of the
common hepatic artery. (a) The arterial phase CEUS
image demonstrates a gradual inow of microbubbles into
the false aneurysm sac, which is located in the otherwise
nonenhanced pancreatic head cyst. The common hepatic
artery stent (arrow) is enhanced. (b) CE-CT demonstrates
the connection of the pseudoaneurysm with the gastroduodenal artery (arrow)
18 Major Blood Vessels
321
a
b
c
Fig. 18.8 False aneurysm of the right internal carotid
artery. (a) Grayscale with CDI sonography reveals the
artery kinking. (b). The arterial phase CEUS image dem-
plaque structure features, such as ulceration or
large hypoechoic area under the surface, indicate
the transition of the stable plaque to an unstable
condition. Unstable atherosclerotic plaques are
associated with a high risk of thrombosis and
embolism of distal branches, which can lead to a
stroke [14–17].
onstrates the enhancement of the aneurism sac. (c)
Volumetric representation of CE-CT of the same lesion
From the point of view of pathology, this transition is a consequence of the progressive inammation of the vascular wall. It implicates the
increase in the density of vasa vasorum and neovascularization of the atherosclerotic plaque [18,
19]. The clinical manifestation of the plaque is
associated with prominent neovascularization.
322
Fig. 18.9 Atherosclerotic plaque in the internal carotid artery. The arterial phase CEUS image demonstrates a regular
cap and avascular structure of the plaque (arrow)
M. G. Tukhbatullin et al.
Currently, there is an opinion that vasa vasorum
within the plaque is an independent predictor of
hemorrhage and plaque rupture with possible
embolism [17]. Therefore, neovascularization is
considered in determining the indications and type
of surgical intervention in addition to the grade of
stenosis, the plaque composition features, and the
state of the surface of the atherosclerotic plaque.
The use of UCAs provides new opportunities
for the diagnosis of atherosclerotic lesions. It signicantly improves the imaging of the vascular
lumen regardless of the angle and scanning plane.
CEUS enables the detection of local brous cap
ulceration and increased neovascularization of the
plaque. Besides, it is more accurate in the estimation of the degree and geometry of stenosis.
To assess the plaque neovascularization, the
following grades may be used [20]:
• Grade 0: no appearance of neovascularization
within the plaque (Fig.18.9)
• Grade 1: the limited appearance of neovascularization within the plaque
• Grade 2: moderate neovascularization
(Figs.18.10 and 18.11)
• Grade 3: the presence of a pulsating arterial
vessel within the plaque
Therefore, CEUS is a promising non-invasive
method for the diagnosis of vascular pathologies,
which facilitates risk assessment and the choice
of management strategy.
18 Major Blood Vessels
a
b
323
c
Fig. 18.10 Atherosclerotic plaque of carotid bifurcation
with the transition to the external carotid artery and the
proximal segment of the internal carotid artery. (a)
Grayscale sonography. (b) CDI. (c) CEUS image demon-
strates the enhancement of the arterial lumen with the
improved delineation of the geometry and length of the
stenotic area. Pronounced asymmetric accumulation of
microbubbles within the plaque is identied
324
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M. G. Tukhbatullin et al.
Fig. 18.11 Atherosclerotic plaque with prominent neovascularization. CEUS images demonstrate progressive
inow of UCA into the plaque. (a) Multiple neovessels
are visualized within the plaque in the arterial phase. The
References
1. Gillum RF.Epidemiology of aortic aneurysm in the
United States. J Clin Epidemiol. 1995;48(11):1289–
98. https://doi.org/10.1016/0895- 4356(95)00045- 3.
2. Bode PJ, Edwards MJ, Kruit MC, van Vugt
AB.Sonography in a clinical algorithm for early evaluation of 1671 patients with blunt abdominal trauma.
AJR Am J Roentgenol. 1999;172(4):905–11. https://
doi.org/10.2214/ajr.172.4.10587119.
3. Hendrickson RG, Dean AJ, Costantino TG.A novel
use of ultrasound in pulseless electrical activity: the
diagnosis of an acute abdominal aortic aneurysm
rupture. J Emerg Med. 2001;21(2):141–4. https://doi.
org/10.1016/s0736- 4679(01)00362- 6.
4. Miller J, Miller J. Small ruptured abdominal aneurysm diagnosed by emergency physician ultrasound.
Am J Emerg Med. 1999;17(2):174–5. https://doi.
org/10.1016/s0735- 6757(99)90055- 4.
5. Catalano O, Lobianco R, Cusati B, Siani A.Contrastenhanced sonography for diagnosis of ruptured
abdominal aortic aneurysm. AJR Am J Roentgenol.
2005;184(2):423–7. https://doi.org/10.2214/
ajr.184.2.01840423.
6. White RA. Endograft surveillance: a priority for long-term device performance. J Endovasc
Ther. 2000;7(6):522. https://doi.org/10.1177/
152660280000700616.
7. Cuypers P, Buth J, Harris PL, Gevers E, Lahey
R.Realistic expectations for patients with stent-graft
treatment of abdominal aortic aneurysms. Results of
a European multicentre registry. Eur J Vasc Endovasc
Surg. 1999;17(6):507–16. https://doi.org/10.1053/
ejvs.1999.0836.
8. White GH, Yu W, May J.Endoleak--a proposed new terminology to describe incomplete aneurysm exclusion by
an endoluminal graft. J Endovasc Surg. 1996;3(1):124–5.
lling begins from the arterial wall. (b) The plaque is
enhanced in the venous phase with long persistence of the
microbubbles
https://doi.org/10.1583/1074- 6218(1996)003<0124b:>
2.0.CO;2.
9. Pokrovskij AV, editor. Klinicheskaya angiologiya.
[Clinical angiology], vol. 2. Moscow: Medicina;
2004. p.117–28. Russian.
10. Stepanova YA. Luchevye metody diagnostiki kistoznyh obrazovanij podzheludochnoj zhelezy i parapankreaticheskoj zony na etapah hirurgicheskogo
lecheniya [Radiation methods of diagnostics of cystic
lesions of the pancreas and parapancreatic zone at the
stages of surgical treatment]. Dissertation. Moscow.
2009. Russian.
11. Buriev IM, Kornyak BS, Azimov RH, Panova
NV. Redkoe oslozhnenie postnekroticheskoj kisty
podzheludochnoj zhelezy (sluchaj iz praktiki) [A
rare complication of a postnecrotic pancreatic cyst (a
case from practice)]. Annaly Hirurgicheskoj Gepatol.
2000;1:77–80. Russian.
12. Ido K, Isobe K, Kimura K, Adachi M, Tsuruta R,
Ono K, etal. Case of hemorrhagic pancreatic pseudocyst in which ultrasound imaging was useful. J Med
Ultrason. 2004;31(1):41–5. https://doi.org/10.1007/
s10396- 003- 0002- 7.
13. Isaeva IV, Cygel’nikov SA, Teplickij EA, Ryazanova
TV. Anevrizmy vnecherepnogo otdela vnutrennej
sonnoj arterii. [Aneurysms of the extracranial part
of the internal carotid artery]. Angiol Sosud Khir.
2007;13(1):143–51. Russian.
14. Gray-Weale AC, Graham JC, Burnett JR, Byrne
K, Lusby RJ. Carotid artery atheroma: comparison of preoperative B-mode ultrasound appearance
with carotid endarterectomy specimen pathology. J
Cardiovasc Surg. 1988;29(6):676–81.
15. Kulikov VP.Ul’trazvukovaya diagnostika sosudistyh
zabolevanij [Ultrasound diagnostics of vascular diseases]. Moscow: Strom; 2011. Russian.
16. Husain T, Abbott C, Scott J, Gough M.Macrophage
accumulation within the cap of carotid atherosclerotic
18 Major Blood Vessels
325
plaques is associated with the onset of cerebral ischemic events. J Vasc Surg. 1999;30(2):269–76. https://
doi.org/10.1016/S0741- 5214(99)70137- 0.
17. Kolodgie FD, Narula J, Yuan C, Burke AP, Finn AV,
Virmani R.Elimination of neoangiogenesis for plaque
stabilization: is there a role for local drug therapy? J
Am Coll Cardiol. 2007;49(21):2093–101. https://doi.
org/10.1016/j.jacc.2006.10.083.
18. Partovi S, Loebe M, Aschwanden M, Baldi T, Jäger
KA, Feinstein SB, Staub D.Contrast-enhanced ultrasound for assessing carotid atherosclerotic plaque
lesions. AJR Am J Roentgenol. 2012;198(1):W13–9.
https://doi.org/10.2214/AJR.11.7312.
19. Chistiakov DA, Orekhov AN, Bobryshev
YV. Contribution of neovascularization and intraplaque haemorrhage to atherosclerotic plaque progression and instability. Acta Physiol (Oxford).
2015;213(3):539–53.
20. Shah F, Balan P, Weinberg M, Reddy V, Neems R,
Feinstein M, et al. Contrast-enhanced ultrasound
imaging of atherosclerotic carotid plaque neovascularization: a new surrogate marker of atherosclerosis?
Vasc Med. 2007;12(4):291–7. https://doi.org/10.1177
/1358863X07083363.
CEUS forMinimally Invasive
Procedures: Intracavitary CEUS
YuryN.Patrunov , InnaA.Apolikhina ,
EllaI.Peniaeva , AlexanderN.Sencha ,
andAynaS.Saidova
19
Ultrasound monitoring of interventional procedures with microbubble injection has many
advantages over traditional US, CT, or MRI and
assumes both intravenous and intraluminal UCA
administration. Microbubble contrast media can
be introduced into any physiological or pathological cavity of the body to estimate its composition, potential stula, the position of the
drainage system, patency of a hollow organ or
duct (e.g., fallopian tubes, biliary system, or
reux detection), etc. [1–7]. CEUS is feasible for
the identication of viable tumor tissue to guide
biopsies and monitor ablative techniques, such as
radiofrequency or thermal ablation [8–12].
The EFSUMB guidelines and recommendations for the clinical practice of CEUS in nonhepatic applications (2017) advise intravenous
UCA injection to assist interventional procedures
and achieve the following goals [13]:
Supplementary Information The online version contains supplementary material available at [https://doi.
org/10.1007/978- 3- 030- 91764- 7_19].
• to delineate the abscess cavity or necrotic area
for efcient drainage
• to avoid necrotic tissue or identify perfused
tissue in the biopsy of tumors
• to identify biopsy targets inconspicuous on
US
• to manage patients treated with ablation
therapies
Intracavitary CEUS is useful for the following
purposes, optionally supplemented by intravenous CEUS [13]:
• identication of needle or catheter position
• delineation of any cavity or duct
• improved tracking of a stula
Intracavitary CEUS may contribute to many
minimally invasive diagnostic or therapeutic
modalities, such as listed below [13]:
Y. N. Patrunov (*) · E. I. Peniaeva
Department of Ultrasound Diagnostics of the Center
for Radiological Diagnostics, Private Healthcare
Institution “Clinical Hospital “RZD-Medicina” of
Yaroslavl City”, Yaroslavl, Russian Federation
I. A. Apolikhina · A. S. Saidova
Department of Aesthetic Gynecology and
Rehabilitation, Federal State Budget Institution
“National Medical Research Center for Obstetrics,
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2022
A. N. Sencha, Y. N. Patrunov (eds.), Contrast-Enhanced Ultrasound,
https://doi.org/10.1007/978-3-030-91764-7_19
Gynecology and Perinatology n.a. V.I.Kulakov”,
Moscow, Russian Federation
A. N. Sencha
Department of Visual and Functional Diagnostics,
Federal State Budget Institution “National Medical
Research Center for Obstetrics, Gynecology and
Perinatology n.a. V.I.Kulakov”,
Moscow, Russian Federation
327