Value of conventional ultrasound and contrast-enhanced ultra-sound in the diagnosis and follow-up of transient perivascular inflammation of the carotid artery syndrome

Mengke Zhang; Nan Li

Abstract：Background Transient perivascular inflammation of the carotid artery (TIPIC) syndrome is relatively rare. Current research on conventional ultrasound and contrast-enhanced ultrasound (CEUS) for examining this condition is predominantly confined to case reports. Therefore, this study aimed to evaluate the value of conventional ultrasound and CEUS in the diagnosis and follow-up of TIPIC syndrome. Methods The study conducted a retrospective analysis of 30 patients with TIPIC syndrome who were treated between January 2016 and September 2025. We analyzed their conventional ultrasonographic and CEUS features and compared the evolution of these characteristics during follow-up visits (14 days, 1 month, 3 months, and 6 months). Results The mean (±standard deviation) maximum thickness of the lesions was 4.4±0.9 mm, and the mean involved length of the lesions was 24.2±8.1 mm. A Pearson correlation analysis showed that the maximum thickness of the lesions was positively correlated with lesion length at the initial visit, 14-day follow-up, and 1-month follow-up (r=0.442, r=0.465, and r=0.802; P=0.014, P<0.001, and P<0.001, respectively). On conventional ultrasound, TIPIC lesions typically presented as unilateral (100%), eccentric (100%), with perivascular wall thickening of the common carotid artery or its bifurcation (100%), and appeared as hypoechoic areas without luminal stenosis (100%). On CEUS, these lesions were mainly diffuse (93.3%) and showed hyperenhancement (90%). During the follow-up, all patients showed a gradual reduction in the lesion thickness and involved area (both P<0.001), accompanied by significantly decreased CEUS enhancement intensity (P<0.001). Most lesions resolved completely within 3 months or earlier (93.3%). Conclusions Conventional ultrasound and CEUS can provide diagnostic imaging evidence for TIPIC syndrome. These techniques play a crucial role in the diagnosis, evaluation of treatment efficacy, and follow-up monitoring of this syndrome, and should be considered the first-line imaging modality.