title: Far-wall pseudoenhancement during contrast-enhanced ultrasound of the carotid arteries: clinical description and in vitro reproduction.
abstract: The present study describes the presence of pseudoenhancement during contrast-enhanced ultrasound (CEUS) imaging of human carotid arteries and the reproduction of this pseudoenhancement in vitro. Seventy patients underwent bilateral CEUS examination of the carotid arteries using a Philips iU22 ultrasound system equipped with a L9-3 ultrasound probe and SonoVue microbubble contrast. During CEUS of the carotid arteries, we identified enhancement in close proximity to the far wall, parallel to the main lumen. The location of this enhancement does not correlate to the anatomical location of a parallel vessel. To corroborate the hypothesis that this is a pseudoenhancement artifact, the enhancement was recreated in a tissue-mimicking material phantom, using the same ultrasound system, settings and contrast agent as the patient study. The phantom study showed that pseudoenhancement may be present during vascular CEUS and that the degree of pseudoenhancement is influenced by the size and concentration of the microbubbles. During vascular CEUS, identification of the artifact is important to prevent misinterpretation of enhancement in and near the far wall.
authors.affiliation: Division of Pharmacology, Vascular and Metabolic Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands. g.l.tenkate@erasmusmc.nl
authors.forename: Gerrit L
authors.initials: GL
authors.lastname: ten Kate
authors.forename: Guillaume G J
authors.initials: GG
authors.lastname: Renaud
authors.forename: Zeynettin
authors.initials: Z
authors.lastname: Akkus
authors.forename: Stijn C H
authors.initials: SC
authors.lastname: van den Oord
authors.forename: Folkert J
authors.initials: FJ
authors.lastname: ten Cate
authors.forename: Vijay
authors.initials: V
authors.lastname: Shamdasani
authors.forename: Rob R
authors.initials: RR
authors.lastname: Entrekin
authors.forename: Eric J G
authors.initials: EJ
authors.lastname: Sijbrands
authors.forename: Nico
authors.initials: N
authors.lastname: de Jong
authors.forename: Johan G
authors.initials: JG
authors.lastname: Bosch
authors.forename: Arend F L
authors.initials: AF
authors.lastname: Schinkel
authors.forename: Antonius F W
authors.initials: AF
authors.lastname: van der Steen
mesh_terms: D016477:Artifacts; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D066298:In Vitro Techniques; D008297:Male; D008875:Middle Aged; D019047:Phantoms, Imaging; D010743:Phospholipids; D013459:Sulfur Hexafluoride; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride