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Yeung K, Eiberg JP, Collet-Billon A, Sandholt BV, Jessen ML, Sillesen HH, Eldrup N. 3-D Contrast-Enhanced Fusion Ultrasound for Accurate Volume Assessment of Vessel Lumen and Plaque in Carotid Artery Disease as Compared With Computed Tomography Angiography. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:399-406. [PMID: 38171954 DOI: 10.1016/j.ultrasmedbio.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/20/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE Three-dimensional contrast-enhanced fusion ultrasound (CEFUS) of atherosclerotic carotid arteries provides spatial visualization of the vessel lumen, creating a lumenography. As in 3-D computed tomography angiography (CTA), 3-D CEFUS outlines the contrast-filled lumen. Plaque and vessel contours are distinguished in 3-D CEFUS, allowing plaque volume quantification as a valid estimate of carotid plaque burden. Three-dimensional CEFUS is unproven in intermodality studies, vindicating the assessment of 3-D CEFUS applicability and comparing 3-D CEFUS and 3-D CTA lumenography as a proof-of-concept study. METHODS Using an ultrasound system with magnetic tracking, a linear array transducer and SonoVue contrast agent, 3-D CEFUS acquisitions were generated by spatial stitching of serial 2-D images. From 3-D CEFUS and 3-D CTA imaging, the atherosclerotic carotid arteries were reconstructed with lumenography in an offline software program for lumen and plaque volume quantification. Bland-Altman analysis was used for inter-image modality agreement. RESULTS The study included 39 carotid arteries. Mean lumen and plaque volume in 3-D CEFUS were 0.63 cm3 (standard deviation [SD]: 0.26) and 0.62 cm3 (SD: 0.26), respectively. Lumen volume differences between 3-D CEFUS and 3-D CTA were non-significant, with a mean difference of 0.01 cm3 (SD: 0.02, p = 0.26) and limits of agreement (LoA) range of ±0.11 cm3. Mean plaque volume difference was -0.12 cm3 (SD: 0.19, p = 0.006) with a LoA range of ±0.39 cm3. CONCLUSION There was strong agreement in lumenography between 3-D CEFUS and 3-D CTA. The interimage modality difference in plaque volumes was substantial because of challenging vessel wall definition in 3-D CTA. Three-dimensional CEFUS is viable in quantifying carotid plaque volume burden and can potentially monitor plaque development over time.
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Affiliation(s)
- Karin Yeung
- Department of Vascular Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Jonas Peter Eiberg
- Department of Vascular Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark, Copenhagen, Denmark
| | | | - Benjamin Vikjær Sandholt
- Department of Vascular Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Majken Lyhne Jessen
- Department of Vascular Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Henrik Hegaard Sillesen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Nikolaj Eldrup
- Department of Vascular Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Fresilli D, Di Leo N, Martinelli O, Di Marzo L, Pacini P, Dolcetti V, Del Gaudio G, Canni F, Ricci LI, De Vito C, Caiazzo C, Carletti R, Di Gioia C, Carbone I, Feinstein SB, Catalano C, Cantisani V. 3D-Arterial analysis software and CEUS in the assessment of severity and vulnerability of carotid atherosclerotic plaque: a comparison with CTA and histopathology. Radiol Med 2022; 127:1254-1269. [PMID: 36114929 PMCID: PMC9587943 DOI: 10.1007/s11547-022-01551-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/26/2022] [Indexed: 11/30/2022]
Abstract
Purpose Our purpose is to assess Multiparametric Ultrasound (MPUS) efficacy for evaluation of carotid plaque vulnerability and carotid stenosis degree in comparison with Computed Tomography angiography (CTA) and histology. Material and methods 3D-Arterial Analysis is a 3D ultrasound software that automatically provides the degree of carotid stenosis and a colorimetric map of carotid plaque vulnerability. We enrolled 106 patients who were candidates for carotid endarterectomy. Prior to undergoing surgery, all carotid artery plaques were evaluated with Color-Doppler-US (CDUS), Contrast-Enhanced Ultrasound (CEUS), and 3D Arterial analysis (3DAA) US along with Computerized Tomographic Angiography (CTA) to assess the carotid artery stenosis degree. Post-surgery, the carotid specimens were fixed with 10% neutral buffered formalin solution, embedded in paraffin and used for light microscopic examination to assess plaque vulnerability morphological features.
Results The results of the CTA examinations revealed 91 patients with severe carotid stenoses with a resultant diagnostic accuracy of 82.3% for CDUS, 94.5% for CEUS, 98.4% for 3DAA, respectively. The histopathological examination showed 71 vulnerable plaques with diagnostic accuracy values of 85.8% for CDUS, 93.4% for CEUS, 90.3% for 3DAA, 92% for CTA, respectively.
Conclusions The combination of CEUS and 3D Arterial Analysis may provide a powerful new clinical tool to identify and stratify “at-risk” patients with atherosclerotic carotid artery disease, identifying vulnerable plaques. These applications may also help in the postoperative assessment of treatment options to manage cardiovascular risks.
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Affiliation(s)
- Daniele Fresilli
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Nicola Di Leo
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Ombretta Martinelli
- Department of Surgery "Paride Stefanini'', Vascular and Endovascular Surgery Division, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Luca Di Marzo
- Department of Surgery "Paride Stefanini'', Vascular and Endovascular Surgery Division, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Patrizia Pacini
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Vincenzo Dolcetti
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Giovanni Del Gaudio
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Fabrizio Canni
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Ludovica Isabella Ricci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185, Rome, Italy
| | - Corrado Caiazzo
- Breast Service, Local Health Agency of Naples ASL NA1, Naples, Italy
| | - Raffaella Carletti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Cira Di Gioia
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, Diagnostic Imaging Unit, ICOT Hospital, Sapienza University of Rome, Via Franco Faggiana1668, 04100, Latina, Italy
| | - Steven B Feinstein
- Department of Internal Medicine, Section of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Carlo Catalano
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Vito Cantisani
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
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Wang X, Luo P, Du H, Li S, Wang Y, Guo X, Wan L, Zhao B, Ren J. Ultrasound Radiomics Nomogram Integrating Three-Dimensional Features Based on Carotid Plaques to Evaluate Coronary Artery Disease. Diagnostics (Basel) 2022; 12:diagnostics12020256. [PMID: 35204347 PMCID: PMC8871132 DOI: 10.3390/diagnostics12020256] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 02/01/2023] Open
Abstract
This study aimed to explore the feasibility of ultrasound radiomics analysis before invasive coronary angiography (ICA) for evaluating the severity of coronary artery disease (CAD) quantified by the SYNTAX score (SS). This study included 105 carotid plaques from 105 patients (64 low-SS patients, 41 intermediate-high-SS patients). The clinical characteristics and three-dimensional ultrasound (3D-US) features before ICA were assessed. Ultrasound images of carotid plaques were used for radiomics analysis. Least absolute shrinkage and selection operator (LASSO) regression, which generated several nonzero coefficients, was used to select features that could predict intermediate-high SS. Based on those coefficients, the radiomics score (Rad-score) was calculated. The selected clinical characteristics, 3D-US features, and Rad-score were finally integrated into a radiomics nomogram. Among the clinical characteristics and 3D-US features, high-density lipoprotein (HDL), apolipoprotein B (Apo B), and plaque volume were identified as predictors for distinguishing between low SS and intermediate-high SS. During the radiomics process, 8 optimal radiomics features most capable of identifying intermediate-high SS were selected from 851 candidate radiomics features. The differences in Rad-score between the training and the validation set were significant (p = 0.016 and 0.006). The radiomics nomogram integrating HDL, Apo B, plaque volume, and Rad-score showed excellent results in the training set (AUC, 0.741 (95% confidence interval (CI): 0.646–0.835)) and validation set (AUC, 0.939 (95% CI: 0.860–1.000)), with good calibration (mean absolute errors of 0.028 and 0.059 in training and validation sets, respectively). Decision curve analysis showed that the radiomics nomogram could identify patients who could obtain the most benefit. We concluded that the radiomics nomogram based on carotid plaque ultrasound has favorable value for the noninvasive prediction of intermediate-high SS. This radiomics nomogram has potential value for the risk stratification of CAD before ICA and provides clinicians with a noninvasive diagnostic tool.
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Affiliation(s)
- Xiaoting Wang
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (X.W.); (P.L.); (S.L.); (Y.W.); (X.G.); (L.W.)
| | - Peng Luo
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (X.W.); (P.L.); (S.L.); (Y.W.); (X.G.); (L.W.)
| | - Huaan Du
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (H.D.); (B.Z.)
| | - Shiyu Li
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (X.W.); (P.L.); (S.L.); (Y.W.); (X.G.); (L.W.)
| | - Yi Wang
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (X.W.); (P.L.); (S.L.); (Y.W.); (X.G.); (L.W.)
| | - Xun Guo
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (X.W.); (P.L.); (S.L.); (Y.W.); (X.G.); (L.W.)
| | - Li Wan
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (X.W.); (P.L.); (S.L.); (Y.W.); (X.G.); (L.W.)
| | - Binyi Zhao
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (H.D.); (B.Z.)
| | - Jianli Ren
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (X.W.); (P.L.); (S.L.); (Y.W.); (X.G.); (L.W.)
- Correspondence:
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Tsivgoulis G, Safouris A, Alexandrov AV. Ultrasonography. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Li H, Liu P, Liu P, Hua W, Yang W, Zhang Y, Zhang L, Xing P, Li Z, Zhang Y, Hong B, Yang P, Liu J. Current knowledge of large vascular occlusion due to intracranial atherosclerosis: focusing on early diagnosis. Chin Neurosurg J 2020; 6:32. [PMID: 33014427 PMCID: PMC7528346 DOI: 10.1186/s41016-020-00213-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/27/2020] [Indexed: 11/16/2022] Open
Abstract
Intracranial atherosclerosis (ICAS)-related large vascular occlusion (LVO) was an intractable subtype of acute ischemic stroke (AIS), which always needed rescue angioplasty and stenting and complicated the procedure of endovascular recanalization. Diagnosing ICAS-LVO accurately and early was helpful for both clinical treatment and trials. Digital subtraction angiography (DSA) was unable to provide an early and rapid diagnosis of ICAS-LVO based on current studies. A variety of pre-DSA methods had been used to distinguish ICAS-LVO with other subtypes of ischemic stroke, such as medical histories, clinical presentations, computed tomography or angiography (CT/CTA), and magnetic resonance imaging (MRI/MRA). This article briefly reviewed the status quo of the diagnosis and treatment of ICAS-LVO and summarized early diagnostic methods of ICAS-LVO from different aspects.
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Affiliation(s)
- He Li
- Department of Neurosurgery, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China.,Stroke Center, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China
| | - Peng Liu
- Department of Neurosurgery, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China.,Stroke Center, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China
| | - Pei Liu
- Department of Neurosurgery, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China.,Stroke Center, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China
| | - Weilong Hua
- Department of Neurosurgery, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China.,Stroke Center, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China
| | - Wenjin Yang
- Department of Neurosurgery, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China.,Stroke Center, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China
| | - Yongxin Zhang
- Department of Neurosurgery, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China.,Stroke Center, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China
| | - Lei Zhang
- Department of Neurosurgery, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China.,Stroke Center, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China
| | - Pengfei Xing
- Stroke Center, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China
| | - Zifu Li
- Department of Neurosurgery, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China.,Stroke Center, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China
| | - Yongwei Zhang
- Stroke Center, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China
| | - Bo Hong
- Department of Neurosurgery, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China.,Stroke Center, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China
| | - Pengfei Yang
- Department of Neurosurgery, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China.,Stroke Center, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China
| | - Jianmin Liu
- Department of Neurosurgery, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China.,Stroke Center, Changhai Hospital, Changhai Road Num. 168, Shanghai, 200433 China
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