Evaluation of Ultrasound Microflow Imaging as an Assessment Tool for Digital Arteries in Thromboangiitis Obliterans

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PURPOSE: Thromboangiitis obliterans (TAO) diagnosis is challenging, and arterial imaging plays a major role in identifying distal artery occlusions. The ultrasonic micro-flow imaging (MFI) mode aims to identify small vessels better using high frame rates and adapted filters. Our objective was to compare the digital arterial characterization performance of MFI with digital subtraction angiography (DSA). MATERIALS AND METHODS: We conducted a prospective single-center analysis of patients with suspected TAO to compare DSA results to MFI. Ultrasonic scanning was performed on the ten fingers with a longitudinal view using a 4-18 MHz probe. Four-limb angiography was performed following a standardized protocol. RESULTS: Twenty patients with confirmed TAO (median age 48 years) and seven (median age 40 years) with initially suspected TAO refuted after diagnostic work-up were included. The agreement for detecting arterial occlusion between MFI and DSA was good (Kappa coefficient of 0.83 [0.77‒0.90]). Patency of all digital arteries was found in patients who had ruled-out TAO. Qualitative alterations of the digital arteries were also noted in TAO, with non-parallel walls and a smaller, irregular diameter. CONCLUSION: Ultrasound imaging using MFI mode for digital artery analysis is a promising contender to DSA for diagnosing TAO. Careful analysis allows for the detection of occlusion-recovery, flow analysis, and the detection of parietal arterial anomalies. This non-invasive examination could, therefore, become a major tool for assessing digital arteries in cases of suspected TAO.

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