Ultrasound in Med. & Biol.. Vol. 23. No. Y. pp, 12lY-1323. 1997 Copyright 0 1997 World Federation for Ultrasound in Medicine & Biology Printed in the USA. All right? reserved 0301-Sb’9/97 TI 7.00 + .OO ELSEVIER l Original Contribution PI1 SO301-5629(97)00145-2 OPHTHALMIC ARTERY ANEURYSMS: AN INVESTIGATION BY DUPLEX SCAN Ltisz~6 J. MOLNAR,? Jo& GUILHERME M. P. CALDAS,? VITAL PAULINO COSTA$* and GIOVANNI GUIDO CERRI~ ‘Division of Radiology, Heart Institute, University of Sao Paulo, Medical School, S&oPaulo, Brazil; and *Department of Ophthalmology, Hospital das Clinicas, University of SHoPaulo, Medical School. S&oPaulo. Brazil; and *Glaucoma Service, University of Campinas. Brazil (Received 4 Janmy 1997; in jinal form 14 h/y 1997) Abstract-With the objective of analyzing the postaneurysmal peak systolic velocity (PSV) in ophthalmic arteries, duplex scanning was analyzed in 28 carotid-ophthalmic artery segments after exclusion of ipsilateral carotid stenosis. For comparison, the angiographic study of the extracranial and intracranial carotid system was utilized as the “gold standard.” A subgroup of 7 subjects with 8 ophthalmic arteries with aneurysms identified where the artery leaves the internal carotid artery presented with PSVs significantly reduced (mean PSVs 17.95 f 7.99 cm/s) compared to the mean PSVs in the healthy group (27.95 f 5.54 cm/s) (p = 0.006). A PSV of less than 19 cm/s offered a sensitivity of 80% and a specificity of 100% in diagnosing ophthalmic artery aneurysms. We conclude that duplex scan is diagnostically useful in the identification of patients with ophthalmic artery aneurysms when severe ipsilateral carotid stenosis is excluded. 0 1997 World Federation for Ultrasound in Medicine 8z Biology. Key Words: Transorbital Doppler, Ophthalmic artery, Aneurysm of the ophthalmic artery. INTRODUCTION The employment of duplex scan (DS) for the evaluation of blood-flow velocities in the ophthalmic artery is new (Erickson et al. 1989). (Lieb et al. 1991) reported a patient with vision loss associated with occlusion of the ipsilateral internal carotid artery and a significant reduc- tion in the blood-flow velocity of the corresponding ophthalmic artery. Other studies (Ho et al. 1992; Hu et al. 1993) have demonstrated notably reduced blood-flow velocities in the ophthalmic and central retinal arteries of patients with severe occlusive carotid artery disease (ste- notic lesion greater than 70% of the ipsilateral bifurca- tion). However, no description has been given of the hemodynamic effect of ophthalmic artery aneurysms on the retrobulbar circulation. The objective of the study was to answer 2 ques- tions: 1. To what extent is a normal DS reliable in ruling out the presence of morphological changes in the carotid- ophthalmic artery segment? 2. Subsequently, how valu- able is orbital DS in the identification of an internal Address correspondence to: Dr. L&z16 J. Molnir, Av das Mag- nolias 449, Cidade Jardim. S*o Paulo 05674-001 Braiil. carotid aneurysm at the site of origin of the ophthalmic artery (Fig. 1)? MATERIAL AND METHODS Between August 1993 and December 1994, 65 patients 42 men and 23 women, 28 to 72 y old, (average 61 -C 9.2) with clinical findings suggestive of a cerebral vascular accident were referred to our ser- vice. All of them underwent an angiographic study by digital subtraction (DVI, Super 80 CP Phillips), to evaluate the extracranial and intracranial carotid cir- culation. Further, all patients underwent DS (7.5 MHz: P700 Phillips) of the carotid and ophthalmic arteries. The angiograms were analyzed by an experienced neuroradiologist who was masked to the results of the DS. According to the angiographic results, 14 patients (10 men and 4 women, 31 to 44 y old [average 37 i- 71) with aneurysms of the ophthalmic segment of the internal carotid artery were identified and subse- quently submitted to a comparative analysis between the DS and angiographic study. In the evaluation of the carotid arteries by DS, a peak systolic velocity (PSV) of less than 120 cm/s was 1319