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What Does My Ultrasound Scan Report Indicate?
Question: I would like your thoughts on some of my carotid artery exam numbers. CCA, ICA and ECA in particular...
Brief Answer:
Looks fine.
Detailed Answer:
I read your question carefully and I understand your concern.
I must say that that photo doesn't give a complete picture, we do not see the column headings at all and interfaces may vary between different ultrasound machines.
However even with those reserves, I would still say that there is not much wrong in those numbers. Carotid doppler ultrasound is done to check for narrowing of the carotid arteries, usually of the ICA (internal carotid artery) where the atherosclerotic plaques form (the CCA is affected less frequently and the ECA doesn't really matter that much).
That is done through direct visualization of the vessels, as well as by measuring the blood flow velocity, when narrowed the velocity is raised. That table you have photographed shows the velocities at different segments and at different stages (during the systole and the diastole).
While again the column headings are not visible, the observed numbers should be normal, the main parameter the peak flow velocity (PSV) which must be the 1st and 3rd column is well below 125 cm/s which is the normal threshold, and the EDV which must be the 2nd and 4th column is well below the threshold of 40 cm/s as well. The other parameter commonly measures is the PSV ratio between the ICA and CCA which should be less then 2, comfortably lower than that in your case. So from what can be seen on that photo everything is fine.
I hope to have been of help.
Looks fine.
Detailed Answer:
I read your question carefully and I understand your concern.
I must say that that photo doesn't give a complete picture, we do not see the column headings at all and interfaces may vary between different ultrasound machines.
However even with those reserves, I would still say that there is not much wrong in those numbers. Carotid doppler ultrasound is done to check for narrowing of the carotid arteries, usually of the ICA (internal carotid artery) where the atherosclerotic plaques form (the CCA is affected less frequently and the ECA doesn't really matter that much).
That is done through direct visualization of the vessels, as well as by measuring the blood flow velocity, when narrowed the velocity is raised. That table you have photographed shows the velocities at different segments and at different stages (during the systole and the diastole).
While again the column headings are not visible, the observed numbers should be normal, the main parameter the peak flow velocity (PSV) which must be the 1st and 3rd column is well below 125 cm/s which is the normal threshold, and the EDV which must be the 2nd and 4th column is well below the threshold of 40 cm/s as well. The other parameter commonly measures is the PSV ratio between the ICA and CCA which should be less then 2, comfortably lower than that in your case. So from what can be seen on that photo everything is fine.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
This is one of the frames taken that has me concerned. I see nodules and some dark areas that concern me. Your thoughts please? In addition to the syncope, I have been experiencing weight gain, very dry skin, a super nasty, strange taste in my mouth, I shiver from inside out, though it's 98 degrees, have pain/ringing/deafness in my left ear and tender lymph nodes on that side. As I may have mentioned before, my TSH is 30, even though I've been on levothyroxine 137 for over a year.
Brief Answer:
Read below
Detailed Answer:
Thank you for the additional images. However an ultrasound is a dynamic test where images depend on the technique and angle the examiner is using, millimeters of change in hand and probe position can completely change the visualized structures.
The neck has many different types of tissue such as muscles, fatty tissue, glands, vessels etc, which have different echogenicity, and result in areas being bright or dark with the form depending on the hand and probe position. So it is perfectly normal to have that mixed appearance that seems to worry you. Furthermore different probes may be used depending on the structure which is studied, when one studies vessels a probe for those structures is used which may not be optimal for other tissues. So this exam is useful only for the carotids not for other structures, not thyroid. Of the two images you have uploaded I can confirm that the velocities in your left carotid are perfectly normal and there is nothing there to explain your symptoms (frankly even without ultrasound the symptoms do not seem related to carotid issues). As for the lymph nodes you mentioned they are not studied in this exam which is focused on the vessels.
Regarding the symptoms I would say that they seem to be at least partially due to low thyroid function as your TSH value and shivering suggests, probably your levothyroxine dosage needs to be increased. As for the ringing and deafness in your left the ultrasound doesn't give much information on that regard, you should be seen first by an ENT specialist for an infection and if nothing wrong is found with the ear then a MRI should be scheduled.
Read below
Detailed Answer:
Thank you for the additional images. However an ultrasound is a dynamic test where images depend on the technique and angle the examiner is using, millimeters of change in hand and probe position can completely change the visualized structures.
The neck has many different types of tissue such as muscles, fatty tissue, glands, vessels etc, which have different echogenicity, and result in areas being bright or dark with the form depending on the hand and probe position. So it is perfectly normal to have that mixed appearance that seems to worry you. Furthermore different probes may be used depending on the structure which is studied, when one studies vessels a probe for those structures is used which may not be optimal for other tissues. So this exam is useful only for the carotids not for other structures, not thyroid. Of the two images you have uploaded I can confirm that the velocities in your left carotid are perfectly normal and there is nothing there to explain your symptoms (frankly even without ultrasound the symptoms do not seem related to carotid issues). As for the lymph nodes you mentioned they are not studied in this exam which is focused on the vessels.
Regarding the symptoms I would say that they seem to be at least partially due to low thyroid function as your TSH value and shivering suggests, probably your levothyroxine dosage needs to be increased. As for the ringing and deafness in your left the ultrasound doesn't give much information on that regard, you should be seen first by an ENT specialist for an infection and if nothing wrong is found with the ear then a MRI should be scheduled.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your detailed reply. I have learned invaluable information regarding the ultrasound images. There was so much mixed in the way of mixed appearances that I felt sure I was looking at something serious.
Please have a look at my MRIs (no flair in these images) and perhaps you can tell me what you do see. Please be as detailed on the brain MRI as you were with the carotid. I don't want you to be vague, but rather pointed, and honest. Thank you!
Please have a look at my MRIs (no flair in these images) and perhaps you can tell me what you do see. Please be as detailed on the brain MRI as you were with the carotid. I don't want you to be vague, but rather pointed, and honest. Thank you!
Brief Answer:
Read beliw
Detailed Answer:
Hello again and thank you for your appreciative words!
You say that the images are not flair, but actually about half of them are FLAIR images, the rest T2. As you might know an MRI has different techniques, sequences, T2 and FLAIR are among the main ones but there are others.
If I were to judge based only on those images I would say that they look normal. They are not enough though, as you may have seen there are hundreds of images in an MRI exam, in different sequences and different planes, the images do not include not even at least one full sequence. If you have the CD or DVD of the MRI you can send me the whole exam. I know it is not practical to can them as separate images. What you can do is to create a disc image, a single file containing all the images, upload that file on a file sharing service like say Dropbox or Google drive and then put the link here. That way I can download the full exam to view it. I hope I am making sense to you. Otherwise on those images I don't see any abnormality.
Read beliw
Detailed Answer:
Hello again and thank you for your appreciative words!
You say that the images are not flair, but actually about half of them are FLAIR images, the rest T2. As you might know an MRI has different techniques, sequences, T2 and FLAIR are among the main ones but there are others.
If I were to judge based only on those images I would say that they look normal. They are not enough though, as you may have seen there are hundreds of images in an MRI exam, in different sequences and different planes, the images do not include not even at least one full sequence. If you have the CD or DVD of the MRI you can send me the whole exam. I know it is not practical to can them as separate images. What you can do is to create a disc image, a single file containing all the images, upload that file on a file sharing service like say Dropbox or Google drive and then put the link here. That way I can download the full exam to view it. I hope I am making sense to you. Otherwise on those images I don't see any abnormality.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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