The thickness of the intima cannot be directly imaged on the B-mode ultrasound image because it typically measures 0.2 mm or less and is below the resolution of transcutaneous ultrasound, and the intima-media interface corresponding to the internal elastic lamina is not consistently visualized. The echogenic line seen at the transition between the media and the adventitia corresponds to the location of the external elastic lamina as seen on pathologic studies, while the internal elastic lamina is not discernable. In normal arteries, the interfaces between the lumen-intima and media-adventitia produce two parallel echogenic lines, with an intervening zone of low echoes that corresponds to the media. The three layers are discernable on B-mode (gray-scale) ultrasound images of the carotid arteries ( Fig. It densely composed of fibroblasts and connective tissue. The transition zone in between, the carotid bulb, is the site predisposed to plaque formation with mixed morphometric components. It contains a preponderance of elastic and connective tissues in the common carotid artery (CCA), an elastic artery, whereas in the internal carotid artery (ICA), a muscular artery, there is a large proportion of smooth muscle cells intermixed with connective tissue. It is thin and is covered with a lining of endothelial cells. The intima is the innermost layer abutting the lumen. The carotid artery wall is composed of three layers: the intima, the media, and the adventitia. B-Mode Ultrasound of the Normal Carotid Artery Wall
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