Table Of Content

6th Edition Introduction to Vascular Ultrasonography John S. Pellerito, MD, FACR, FSRU, FAIUM Associate Professor of Radiology Hofstra North Shore-LIJ School of Medicine; Associate Chairman Department of Radiology Chief, Division of Ultrasound, CT, and MRI Director, Peripheral Vascular Laboratory North Shore University Hospital Manhasset, New York Joseph F. Polak, MD, MPH Professor of Radiology Tufts University School of Medicine; Vice Chair of Business Development Tufts Medical Center Boston, Massachusetts; Chief of Radiology Lemuel Shattuck Hospital Jamaica Plain, Massachusetts 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 INTRODUCTION TO VASCULAR ULTRASONOGRAPHY ISBN: 978-1-4377-1417-3 Copyright © 2012, 2005, 2000, 1992, 1986, 1983 by Saunders, an imprint of Elsevier Inc. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the Publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluat- ing and using any information, methods, compounds, or experiments described herein. In using such information or methods, they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instruc- tions, or ideas contained in the material herein. Library of Congress Cataloging-in-Publication Data Introduction to vascular ultrasonography -- 6th ed. / [edited by] John S. Pellerito, Joseph F. Polak. p. ; cm. Includes bibliographical references and index. ISBN 978-1-4377-1417-3 (hardcover : alk. paper) I. Pellerito, John S. II. Polak, Joseph F. [DNLM: 1. Vascular Diseases--ultrasonography. 2. Blood Vessels--ultrasonography. WG 500] LC classification not assigned 616.1’307543--dc23 2012006759 Content Strategist: Pamela Hetherington Content Development Specialist: Joanie Milnes Publishing Services Manager: Anne Altepeter Senior Project Manager: Cheryl A. Abbott Design Direction: Ellen Zanolle Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 To Elizabeth, John, Alana, and Daniel for your support and encouragement. To Marie and Peter for being there for me from day one. And to my colleagues and sonographers for making work fun. J.S.P. To Jo-Anne and Alexandra. J.F. P. ACKNOWLEDGMENTS I gratefully acknowledge the following individu- I gratefully acknowledge all of the individuals als who have contributed to this sixth edition. who have contributed to this sixth edition. My co-editor, Joseph Polak, for his insights, My greatest thanks go to my co-editor, John expertise, and humor throughout the writing and Pellerito, for sharing his knowledge and opti- editorial process. mism throughout the writing and editorial pro- All the authors who contributed their time, cess. I especially thank him for taking me on as energy, and outstanding chapters. his co-editor for this truly unique textbook of My administrative assistant, Barbara Stanco, vascular ultrasound. for her patience and support. I would like to recognize the efforts of all of the My co-workers in the Peripheral Vascu- chapter authors and co-authors who have spent lar Laboratory, James Naidich, MD; Catherine so much of their precious time preparing their D’Agostino, MD; Brian Burke, MD; Danielle chapters, especially colleagues who have shared Berne, RN; Bindu Rameshan, RVT; Jane Joo Ah their knowledge when participating at various Kim, RVT; John Torres, RVT; Glenn Prucha; Dan- continuing medical education venues, primar- iel Hernandez, RVT; and Christine Antoldi. ily the long running Current Practice in Vascu- My chief technologists, Amalia Pose and lar Ultrasound (www.IAME.com), the AIUM Saiedeh “Nanaz” Maghool and all of the sono- (www.AIUM.org), the RSNA (www.RSNA.org), graphers at North Shore for their commitment to and the ACR (www.ACR.org). excellence. I give my special thanks and gratitude to the Joanie Milnes, Pamela Hetherington, Cheryl sonographers who have contributed materials Abbott, Rebecca Gaertner, and all at Elsevier for to this book: Jean M. Alessi-Chinetti, Gregory Y. their help and expertise. Curto, and Richard J. Porter. Irwin Kuperberg and everyone at IAME for I thank all of the staff of Elsevier who had to put their dedication to medical education and their up with my sometimes finicky requests in order to support of vascular ultrasound. prepare an improved edition of this book. And always, my family, Elizabeth, John, Alana, I especially thank my wife, Jo-Anne, and daugh- Daniel, Peter, Mom, and Dad, for their continu- ter, Alexandra, for putting up with my work habits ing support and understanding. and for my takeover of our living room to accom- modate my workstation and its’ 30-inch screen. John S. Pellerito, MD, FACR, FSRU, FAIUM Joseph F. Polak, MD, MPH vii ABOUT THE EDITORS John S. Pellerito, MD, FACR, FSRU, FAIUM, is Associ- ate Professor of Radiology at Hofstra North Shore-LIJ School of Medicine. He is Associate Chairman of Stra- tegic Planning and Technology at North Shore Uni- versity Hospital in Manhasset, New York. He is also Chief of the Division of Ultrasound, CT, and MRI; the Director of the Peripheral Vascular Laboratory at North Shore University Hospital; the Director of the Body Imaging Fellowship Program; and the author of multiple original articles, book chapters, web lectures, and DVD programs. His practice focuses on cardiovascular and gynecologic diseases. His current interests include new imaging technologies and approaches to the diagnosis of vascular and oncologic diseases. He is an acclaimed national and international speaker and contributes to multiple CME programs. Dr. Pellerito holds multiple editorial appointments and is a board examiner for the American Board of Radiology. He has served on the board of the Intersocietal Accredi- tation Commission for the accreditation of vascular laboratories and American Institute of Ultrasound in Medicine. He is a fellow of the American College of Radiology, Society of Radiologists in Ultrasound, and American Institute of Ultrasound in Medicine. He and his wife, Elizabeth, have three children: John, Alana, and Daniel. Joseph F. Polak, MD, MPH, is Professor of Radiology at Tufts University School of Medicine, Director of the Ultrasound Reading Center at Tufts Medical Cen- ter, as well as Chief of Radiology at the Lemuel Shat- tuck Hospital in Boston, Massachusetts. A graduate of McGill University Medical School, he holds a master’s degree in public health from the Harvard School of Public Health. He has co-authored more than 250 peer-reviewed articles and more than 80 non–peer- reviewed articles and chapters. He has served on the editorial board of Radiology, the Journal of Neuroimag- ing, the Journal of Vascular Ultrasound, and the Journal of Ultrasound in Medicine. He is a prior president of the Intersocietal Accreditation Commission for the accreditation of vascular laboratories. His research interests include interventional radiology, non-invasive vascular imaging, and the development of biomarkers for the detection and monitoring of early atherosclerosis. He has been principal investigator on two RO-1 grants studying the progression of atherosclerosis with carotid artery intima-media thickness and co- investigator on multiple other NIH grants. ix PREFACE The sixth edition of Introduction to Vascular Ultra- leaders in vascular ultrasound. His curriculum sonography is a major update to our previous vitae includes many original papers utilizing editions. First, I would like to welcome my new duplex ultrasound in diagnosis of carotid and co-editor, Joseph F. Polak, to this edition. Jo and venous disease. His expertise extends to 10 chap- I have collaborated for many years on multiple ters in this edition. New topics include evaluation projects and at numerous meetings, most nota- of the abdominal aorta, screening for vascular bly our Current Practice of Vascular Ultrasound disease, and correlative imaging with CT and MR program, which is approaching its twentieth angiography. anniversary. Having produced separate vascular There are 29 authors involved in this edition. publications, we decided to collaborate on this All the authors have contributed to the field of edition, hoping to create the definitive vascular vascular ultrasound, and we are proud to include ultrasound textbook. We are very pleased to find their material. Each has made a substantial contri- that this partnership produced an inclusive tome bution with expanded and new chapters. Signifi- that surpassed our expectations. We added sev- cant additions to this edition include enhanced eral new chapters that focus on growing areas of versions of the role of ultrasound contrast in vas- vascular ultrasound and updated previous chap- cular imaging, the role of ultrasound in manage- ters with the assistance of leading experts in our ment of cerebrovascular disease, and evaluation field. We believe the most popular text on vascu- of the hepatic vasculature. New topics include lar ultrasound is now significantly improved. assessment of carotid interventions, evaluation of As an interventional radiologist and vascular organ transplants, and accreditation and the vas- specialist, Dr. Polak brings extraordinary expe- cular laboratory. rience in medical imaging and vascular medicine to this edition. Jo Polak is one of the true John S. Pellerito, MD, FACR, FSRU, FAIUM xi CONTRIBUTORS Andrei V. Alexandrov, MD Brian J. Burke, MD, RVT Professor and Director Attending Radiologist Comprehensive Stroke Center Department of Radiology University of Alabama Hospital North Shore University Hospital; Birmingham, Alabama Assistant Professor Department of Radiology Clotilde Balucani, MD Hofstra North Shore-LIJ School of Medicine Department of Neurology Manhasset, New York University of Perugia Perugia, Italy; Stefan A. Carter, MD, MSC, FRCP(C) Research Fellow Professor of Physiology and Medicine Comprehensive Stroke Center University of Manitoba University of Alabama Hospital Winnipeg, Manitoba, Canada Birmingham, Alabama John J. Cronan, MD Dennis F. Bandyk, MD Professor and Chairman Professor of Surgery Brown Alpert Medical School; University of South Florida Department of Diagnostic Imaging College of Medicine Radiologist-in-Chief Tampa, Florida Rhode Island Hospital Providence, Rhode Island Phillip J. Bendick, PhD Director Joshua Cruz, RVT Peripheral Vascular Diagnostic Center Technical Director and Manager William Beaumont Hospital Yale Vascular Laboratory Royal Oak, Michigan Yale University School of Medicine New Haven, Connecticut Carol B. Benson, MD Professor of Radiology Daniel T. Ginat, MD, MS Harvard Medical School; Radiology Resident Director of Ultrasound University of Rochester Medical Center Co-Director of High Risk Obstetrical Ultrasound Rochester, New York Brigham and Women’s Hospital Edward G. Grant, MD Boston, Massachusetts Chairman and Professor George L. Berdejo, BA, RVT Department of Radiology Director, Vascular Ultrasound Imaging Services University of Southern California Moses, North, and Weiler-Einstein Divisions University Hospital Division of Vascular Surgery Los Angeles, California Department of Cardiovascular and Thoracic Ulrike M. Hamper, MD, MBA Surgery Professor of Radiology, Urology, and Pathology; Montefiore Director, Division of Ultrasound Bronx, New York Russell H. Morgan Department of Radiology Edward I. Bluth, MD, FACR and Radiological Science Professor The Johns Hopkins University Ochsner Clinical School School of Medicine University of Queensland School of Medicine; Baltimore, Maryland Chairman Emeritus Radiology Ochsner Health System New Orleans, Louisiana xiii xiv CONTRIBUTORS Kelly Hodgkiss-Harlow, MD Daniel A. Merton, BS, RDMS, FSDMS, FAIUM Division of Vascular and Endovascular Surgery Clinical Instructor and Technical Coordinator University of South Florida College of Medicine of Research Tampa, Florida Jefferson Ultrasound Research and Education Institute Sandra Katanick, RN, RVT, FSVU, CAE Department of Radiology Chief Executive Officer Jefferson Medical College Intersocietal Accreditation Commission Thomas Jefferson University Ellicott City, Maryland Philadelphia, Pennsylvania Gregory M. Keck, MD William D. Middleton, MD, FACR Interventional Radiologist Professor of Radiology Southwest Medical Imaging Associates; Mallinckrodt Institute of Radiology Department of Radiology Washington University in St. Louis Midland Memorial Hospital St. Louis, Missouri Midland, Texas Darius G. Nabavi, MD Evan C. Lipsitz, MD Professor Associate Professor of Surgery Department of Neurology Albert Einstein College of Medicine; Klinikum Neukölln Medical Director, Vascular Diagnostic Berlin, Germany Laboratory Services Chief, Division of Vascular Surgery Laurence Needleman, MD Department of Cardiovascular and Thoracic Medical Director, Noninvasive Vascular Surgery Laboratory Montefiore Thomas Jefferson University Hospitals; Bronx, New York Associate Professor of Radiology Jefferson Medical College Mark E. Lockhart, MD, MPH Thomas Jefferson University Professor of Radiology Philadelphia, Pennsylvania Chief, Body Imaging Section Chief, GU Radiology Marsha M. Neumyer, BS, RVT, FSDMS, FSVU, University of Alabama at Birmingham FAIUM Birmingham, Alabama International Director Vascular Diagnostic Educational Services Mahan Mathur, MD Harrisburg, Pennsylvania Department of Diagnostic Radiology Yale University School of Medicine Shirley M. Otis, MD New Haven, Connecticut Director The Brain Research and Treatment Center Michelle Melany, MD Scripps Clinic Clinical Professor of Radiology La Jolla, California University of California Los Angeles David Geffen School of Medicine; John S. Pellerito, MD, FACR, FSRU, FAIUM Vice Chair of Radiology Associate Professor of Radiology Greater Los Angeles VA Medical Center; Hofstra North Shore-LIJ School of Medicine; Chief of Women’s Imaging Associate Chairman Cedars Sinai Imaging Medical Group Department of Radiology Los Angeles, California Chief, Division of Ultrasound, CT, and MRI Director, Peripheral Vascular Laboratory North Shore University Hospital Manhasset, New York CONTRIBUTORS xv Joseph F. Polak, MD, MPH Deborah Rubens, MD Professor of Radiology Professor of Imaging Sciences, Oncology, and Tufts University School of Medicine; Biomedical Engineering Vice Chair of Business Development Associate Chair, Imaging Sciences Tufts Medical Center Associate Director for the Center for Biomedical Boston, Massachusetts; Ultrasound Chief of Radiology University of Rochester Medical Center Lemuel Shattuck Hospital Rochester, New York Jamaica Plain, Massachusetts Leslie M. Scoutt, MD Margarita V. Revzin, MS, MD Professor of Diagnostic Radiology and Surgery Assistant Professor of Radiology Yale University School of Medicine; Yale University School of Medicine Chief, Ultrasound Service New Haven, Connecticut Medical Director, Non-Invasive Vascular Laboratory E. Bernd Ringelstein, MD Yale-New Haven Hospital Professor of Neurology New Haven, Connecticut Department of Neurology University Hospital Münster Steven R. Talbot, RVT, FSVU Münster, Germany Research Associate Division of Vascular Surgery Martin A. Ritter, MD Technical Director, Vascular Laboratory Consultant Neurologist Cardiovascular Services Head of the Stroke Unit University of Utah Medical Center Department of Neurology Salt Lake City, Utah University Hospital Münster Münster, Germany James A. Zagzebski, PhD Professor and Chairman Michelle L. Robbin, MD, MS Department of Medical Physics Professor of Radiology and Biomedical University of Wisconsin Engineering Madison, Wisconsin Chief of Ultrasound University of Alabama at Birmingham R. Eugene Zierler, MD Birmingham, Alabama Professor of Surgery University of Washington School of Medicine; Kathryn A. Robinson, MD Medical Director, D.E. Strandness, Jr., Vascular Mallinckrodt Institute of Radiology Laboratory Washington University in St. Louis University of Washington Medical Center and St. Louis, Missouri Harborview Medical Center Seattle, Washington