In ultrasound assessment of arterial plaque ulceration, which finding supports the presence of a true ulcer?

• A. Blood flow within a cavity communicating with the lumen
• B. Absence of blood flow within any cavity
• C. Uniform plaque surface on grayscale
• D. No need for color Doppler

Answer: (A)

The finding that supports a true arterial plaque ulcer is a crater-like cavity within the plaque that communicates with the lumen and shows blood flow filling that cavity. This flow into the cavity, often seen with color Doppler, demonstrates a direct channel between the lumen and the ulcer crater, which is the defining feature of a true ulcer.

Uniform plaque surface on grayscale argues against an ulcer, and absence of flow within a cavity would not confirm an ulcer since a non-communicating cavity or stagnant space doesn’t prove a true ulcer. Color Doppler is essential here because it reveals the lumen-to-ulcer communication that grayscale alone can miss.