Three tissue layers called tunicae, or coats, surround the lumen of an artery. The tunica intima (internal coat) is the innermost lining of an artery composed of endothelial cells and a thin layer of protein called the internal basement membrane.
The intima, as seen in intravascular ultrasound, is normally a thin layer supported by smooth muscle cells, fibroblasts and the internal elastic lamina; this layer thickens substantially, often eccentrically, in atherosclerosis.

Cerebrovascular ultrasonography is the best screening tool for the detection of carotid artery stenosis. Transcranial sonography is used in the evaluation of patients with suspected cerebrovascular disease, but a common problem is the attenuation of the ultrasound signal by the skull.
Contrast enhanced ultrasound play a particularly important role in the visualization of the intracranial vessels, and thus improves the accuracy of transcranial Doppler and increases the potential of this technique. The use of microbubbles is helpful for classification of stenosis and for plaque evaluation in patients with poor initial examination. Ultrasound contrast agents avoid misdiagnosing a subtotal stenosis, which is a very important clinical issue.

See also Adventitia, Intima, Periorbital Doppler, and Acoustic Window.

(IVUS) For intravascular ultrasound a small IVUS catheter with a probe is introduced into the artery. The transducer transmits and receives acoustic energy through this catheter. The reflected acoustic energy is used to build a picture of the inside of the vessel. A IVUS image consists of three layers around the lumen, the intima, media and adventitia.
In addition, elastography or palpography could be used to evaluate the local mechanical properties of tissues (e.g. lipid pools in high-risk vulnerable atherosclerotic plaques). These techniques use the deformation caused by the intraluminal pressure generated by the probe.
A high strain region at the lumen vessel wall boundary has 88% sensitivity and 89% specificity for identifying vulnerable plaques. There are high strain values of 1% in soft plaques with increased strain up to 2% at the shoulders of the plaque, while calcified material shows low strain values (0-0.2%). The radial strain in the tissue is obtained by cross-correlation techniques on the radio frequency signal. The strain is color-coded and plotted as a complimentary image to the intravascular ultrasound echogram.

See also Interventional Ultrasound, Vascular Ultrasound.

Vascular ultrasound obtains images and measures blood flow velocity in the carotids, abdominal aorta, and vessels of kidneys, arms, or legs. Blockages in arteries, blood clots in veins, or abdominal aortic aneurysm can be detected.
These abnormalities in blood flow are usually examined with different Doppler techniques. In addition, the speed and direction of blood flow can be color coded in a color map. Duplex techniques show both, the vessels and the surrounding tissue. The use of ultrasound contrast agents improves the left ventricular opacification in cardiac ultrasound examination. Usually, for a vascular ultrasound no special preparation is needed.

See also Echocardiography, Venous Ultrasound, Adventitia, Intima, Temporal Mean Velocity, and Intravascular Ultrasound.