Why is it recommended to add a neck color Doppler ultrasound instead of neck angiography during the physical examination of the elderly?

In private messages or clinics, patients' families often ask what neck examinations the elderly can do. Generally, patients are advised to do a neck color Doppler ultrasound first. Some family members, out of concern for the patient, suggest angiography, which has high accuracy and clarity. The family members' feelings are understandable, but it is not recommended that patients give priority to angiography for disease screening.

DSA is commonly used to diagnose various vascular diseases and is the gold standard for diagnosing cerebrovascular diseases. It can clearly show the morphology, structure, circulation time, location and degree of stenosis of cerebral blood vessels, size and location of emboli, ischemic compensation, etc.

The accuracy and clarity of DSA examination are indeed higher than those of color Doppler ultrasound, CT, and MRI, but it is an interventional examination and an invasive examination. Moreover, this examination requires contrast agents. Some patients are allergic to contrast agents and develop symptoms such as urticaria, so this examination is not suitable. In addition, the cost of DSA examination is also higher than other costs. Therefore, for patients who are undergoing early disease screening, DSA examination is not the best choice.

Although the accuracy and clarity of color ultrasound of the neck are not as high as those of DSA, from the perspective of disease screening, the accuracy and clarity of color ultrasound can complete the task of screening and diagnosing diseases. Moreover, color ultrasound of the neck is a non-invasive, repeatable and inexpensive examination. It can also diagnose whether there is plaque formation in the carotid artery, the location and size of the plaque, the degree of vascular stenosis, and whether there is occlusion. It is the preferred method for screening carotid artery stenosis clinically.

Other examination methods for carotid artery stenosis: Magnetic resonance angiography (MRA) can show the anatomical location and degree of carotid artery stenosis, but it is not suitable for patients with metal implants in the body. CT angiography (CTA) can also evaluate the degree and location of blood vessel stenosis. It is suitable for patients with metal implants in the body, but not for patients who are allergic to contrast agents.

Therefore, the specific examinations to be performed should be decided based on the patient's specific situation and the doctor's evaluation. It is not the case that the patient can just do whatever examination he wants. The best examination method is the one that suits the patient.