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Sultan SR, Khayat M, Almutairi B, Marzouq A, Albngali A, Abdeen R, Alahmadi AA, Toonsi F. B-mode ultrasound characteristics of carotid plaques in symptomatic and asymptomatic patients with low-grade stenosis. PLoS One 2023; 18:e0291450. [PMID: 37703254 PMCID: PMC10499196 DOI: 10.1371/journal.pone.0291450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/26/2023] [Indexed: 09/15/2023] Open
Abstract
Carotid plaque features assessed using B-mode ultrasound can be useful for the prediction of cerebrovascular symptoms. Therefore, the aim of this retrospective study was to determine the ability of ultrasound B-mode imaging to differentiate between carotid plaques causing less than 50% stenosis in symptomatic and asymptomatic patients. A dataset of 1,593 patients with carotid disease who underwent carotid ultrasound between 2016 and 2021 was evaluated retrospectively between January and April of 2022. A total of 107 carotid plaques from 35 symptomatic and 52 asymptomatic patients causing low-grade stenosis on B-mode images were included in the analysis. Chi-square, independent t-test and Mann-Whitney U test were used to compare the variables. There was a significant association between hypertension and the presence of cerebrovascular symptoms (p = 0.01). Predominantly hypoechoic and hyperechoic carotid plaque were significantly associated with the presence and absence of cerebrovascular symptoms, respectively (predominantly hypoechoic: p = 0.01; predominantly hyperechoic: p = 0.02). Surface irregularity was significantly associated with the presence of cerebrovascular symptoms (p = 0.02). There is was a significant difference in the carotid plaque length and area between the symptomatic and asymptomatic patients (plaque length: symptomatic median 9 mm, interquartile range [IQR] 6 mm; asymptomatic median 6 mm, IQR 4.5 mm, p = 0.01; plaque area: symptomatic median 24 mm, IQR 30 mm; asymptomatic median 14 mm, IQR 17 mm, p = 0.01); however, this difference was not significant for plaque thickness (p = 0.55), or common carotid artery intima-media thickness (p = 0.7). Our findings indicate that hypertension patients with predominantly hypoechoic carotid plaques and plaques with an irregular surface are associated with the presence of cerebrovascular symptoms. In addition, the carotid plaques in symptomatic patients were longer and larger compared to asymptomatic patients.
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Affiliation(s)
- Salahaden R. Sultan
- Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Mohammed Khayat
- Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Bander Almutairi
- Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Abdulhamid Marzouq
- Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad Albngali
- Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rawan Abdeen
- Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Adnan A.S. Alahmadi
- Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fadi Toonsi
- Department of Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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2
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Advances in Noninvasive Carotid Wall Imaging with Ultrasound: A Narrative Review. J Clin Med 2022; 11:jcm11206196. [PMID: 36294515 PMCID: PMC9604731 DOI: 10.3390/jcm11206196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/12/2022] [Indexed: 11/17/2022] Open
Abstract
Carotid atherosclerosis is a major cause for stroke, with significant associated disease burden morbidity and mortality in Western societies. Diagnosis, grading and follow-up of carotid atherosclerotic disease relies on imaging, specifically ultrasound (US) as the initial modality of choice. Traditionally, the degree of carotid lumen stenosis was considered the sole risk factor to predict brain ischemia. However, modern research has shown that a variety of other imaging biomarkers, such as plaque echogenicity, surface morphology, intraplaque neovascularization and vasa vasorum contribute to the risk for rupture of carotid atheromas with subsequent cerebrovascular events. Furthermore, the majority of embolic strokes of undetermined origin are probably arteriogenic and are associated with nonstenosing atheromas. Therefore, a state-of-the-art US scan of the carotid arteries should take advantage of recent technical developments and should provide detailed information about potential thrombogenic (/) and emboligenic arterial wall features. This manuscript reviews recent advances in ultrasonographic assessment of vulnerable carotid atherosclerotic plaques and highlights the fields of future development in multiparametric arterial wall imaging, in an attempt to convey the most important take-home messages for clinicians performing carotid ultrasound.
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Alyami J, Almutairi F. Arterial Stiffness Assessment in Healthy Participants Using Shear Wave Elastography. Curr Med Imaging 2022; 18:1086-1092. [PMID: 35430974 DOI: 10.2174/1573405618666220415124535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/29/2021] [Accepted: 01/29/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Arterial stiffness is an important biomarker for cardiovascular disease. Shear wave elastography (SWE) provides quantitative estimates of tissue stiffness. OBJECTIVE This study aimed to provide reference values for arterial wall, assessing the suitability of SWE to quantify elasticity of the common carotid artery (CCA) and evaluating inter- and intra-observer reproducibility. METHODS A Supersonic Aixplorer ultrasound system with L15-4 probe was used to scan longitudinal sections of the CCA. Young's modulus (YM) was measured within 2-mm regions of interest. Reproducibility was assessed within a subgroup of 16 participants by two operators (one novice and one experienced) during two sessions >one week apart. RESULTS This study involves seventy-three participants with a mean age of 40±10 years and body mass index of 26 ±6 kg/m2. YM estimates were 59 kPa ±19 in men and 56 kPa ±12 in women. The average YM of the CCA walls was 58 kPa ±15 (57 ±15 kPa for the anterior wall and 58 ±20 kPa for the posterior wall, p=0.75). There was no significant difference in the mean of YM estimates of the CCA between the observers (observer: one 51 ±14 kPa and observer two: 55 ±17 kPa [p=0.46]). inter- and intra-observer reproducibility was fair to good (Intra-class correlations, ranging from 0.46 to 0.71). Inter-frame variability was 28%. CONCLUSION In healthy individuals, SWE provided an estimate of YM of the CCA (58 kPa) with fair to good reproducibility. This study demonstrated the potential of using SWE for assessing biomechanical properties of blood vessels.
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Affiliation(s)
- Jaber Alyami
- Department of Diagnostic Radiology, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fahad Almutairi
- Department of Diagnostic Radiology, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah, Saudi Arabia
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Huisman LA, Steinkamp PJ, Hillebrands JL, Zeebregts CJ, Linssen MD, Jorritsma-Smit A, Slart RHJA, van Dam GM, Boersma HH. Feasibility of ex vivo fluorescence imaging of angiogenesis in (non-) culprit human carotid atherosclerotic plaques using bevacizumab-800CW. Sci Rep 2021; 11:2899. [PMID: 33536498 PMCID: PMC7858611 DOI: 10.1038/s41598-021-82568-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 01/11/2021] [Indexed: 01/30/2023] Open
Abstract
Vascular endothelial growth factor-A (VEGF-A) is assumed to play a crucial role in the development and rupture of vulnerable plaques in the atherosclerotic process. We used a VEGF-A targeted fluorescent antibody (bevacizumab-IRDye800CW [bevacizumab-800CW]) to image and visualize the distribution of VEGF-A in (non-)culprit carotid plaques ex vivo. Freshly endarterectomized human plaques (n = 15) were incubated in bevacizumab-800CW ex vivo. Subsequent NIRF imaging showed a more intense fluorescent signal in the culprit plaques (n = 11) than in the non-culprit plaques (n = 3). A plaque received from an asymptomatic patient showed pathologic features similar to the culprit plaques. Cross-correlation with VEGF-A immunohistochemistry showed co-localization of VEGF-A over-expression in 91% of the fluorescent culprit plaques, while no VEGF-A expression was found in the non-culprit plaques (p < 0.0001). VEGF-A expression was co-localized with CD34, a marker for angiogenesis (p < 0.001). Ex vivo near-infrared fluorescence (NIRF) imaging by incubation with bevacizumab-800CW shows promise for visualizing VEGF-A overexpression in culprit atherosclerotic plaques in vivo.
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Affiliation(s)
- Lydian A. Huisman
- grid.4494.d0000 0000 9558 4598Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,grid.4494.d0000 0000 9558 4598Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Pieter J. Steinkamp
- grid.4494.d0000 0000 9558 4598Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan-Luuk Hillebrands
- grid.4494.d0000 0000 9558 4598Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Clark J. Zeebregts
- grid.4494.d0000 0000 9558 4598Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Matthijs D. Linssen
- grid.4494.d0000 0000 9558 4598Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands ,grid.4494.d0000 0000 9558 4598Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annelies Jorritsma-Smit
- grid.4494.d0000 0000 9558 4598Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands ,grid.4494.d0000 0000 9558 4598Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Riemer H. J. A. Slart
- grid.4494.d0000 0000 9558 4598Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,grid.6214.10000 0004 0399 8953Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Gooitzen M. van Dam
- grid.4494.d0000 0000 9558 4598Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,grid.4494.d0000 0000 9558 4598Department of Surgery, Nuclear Medicine and Molecular Imaging and Intensive Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hendrikus H. Boersma
- grid.4494.d0000 0000 9558 4598Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands ,grid.4494.d0000 0000 9558 4598Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Cademartiri F, Balestrieri A, Cau R, Punzo B, Cavaliere C, Maffei E, Saba L. Insight from imaging on plaque vulnerability: similarities and differences between coronary and carotid arteries-implications for systemic therapies. Cardiovasc Diagn Ther 2020; 10:1150-1162. [PMID: 32968666 DOI: 10.21037/cdt-20-528] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Nowadays it is widely accepted that the rupture of the atherosclerotic plaque in coronary and carotid arteries plays a fundamental role in the development of acute myocardial infarctions or cerebrovascular events. In recent years, imaging techniques have explored, with a new level of detail, the atherosclerotic disease generating new evidences that some plaque characteristics are significantly associated to the risk of rupture and subsequent thrombosis or embolization. Moreover, the recent evidence of the anti-atherosclerotic effects determined by lipid-lowering and anti-inflammatory therapies poses a challenge for the choice of therapeutic approaches (best/optimal medical therapy vs. revascularization), maximized by the evidence that coronary and carotid atherosclerosis share common patterns but also differ regarding some important features. In this Review, we discuss the similarities and differences between coronary and carotid artery vulnerable plaque from the imaging point of view and the potential implications for systemic therapies according to the emerging evidence.
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Affiliation(s)
| | | | - Riccardo Cau
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Bruna Punzo
- Department of Radiology, SDN IRCCS, Naples, Italy
| | | | - Erica Maffei
- Department of Radiology, Area Vasta 1, ASUR Marche, Urbino (PU), Italy
| | - Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy
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Rafailidis V, Li X, Sidhu PS, Partovi S, Staub D. Contrast imaging ultrasound for the detection and characterization of carotid vulnerable plaque. Cardiovasc Diagn Ther 2020; 10:965-981. [PMID: 32968654 DOI: 10.21037/cdt.2020.01.08] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Not only the degree of luminal narrowing but also the plaque morphology and composition play an important role in risk stratification of carotid atherosclerotic lesions. During the last few years, carotid contrast-enhanced ultrasound (CEUS) has emerged as a valuable imaging tool to assess such vulnerable carotid plaques. This review article discussed the use of CEUS for the detection of carotid plaque irregularities and ulcerations as well as the quantification of intraplaque neovascularization and its correlation with histology and inflammatory biomarkers. Apart from evaluating for markers of vulnerable carotid plaques, CEUS enhancement is directly associated with past cerebrovascular events. More importantly, preliminary evidence has shown that CEUS could be used to predict future cerebrovascular and cardiovascular events. Despite the progress in CEUS imaging for carotid atherosclerotic disease, past studies still suffer from the retrospective nature, small sample size, and a lack of matched, well controlled prospective studies. In the future, large multi-center prospective studies addressing the relationship between CEUS findings and patient clinical outcomes in carotid atherosclerotic disease are warranted.
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Affiliation(s)
| | - Xin Li
- Department of Internal Medicine, University Hospital Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, London, UK
| | - Sasan Partovi
- Interventional Radiology Section, Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Daniel Staub
- Department of Angiology, University Hospital Basel, University of Basel, Basel, Switzerland
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7
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Artas H, Okcesiz I. Three-dimensional ultrasonographic evaluation of carotid artery plaque surface irregularity. Arch Med Sci 2020; 16:58-65. [PMID: 32051706 PMCID: PMC6963133 DOI: 10.5114/aoms.2018.81135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 11/30/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate 3-dimensional (3D) ultrasonography (US) in determining the surface irregularity of carotid artery plaques. MATERIAL AND METHODS This study included 50 patients (20 females and 30 males) aged between 56 and 82 years with plaques in the carotid artery which were detected during routine neck ultrasound. Simultaneously these cases were evaluated in terms of plaque echogenicities and surface characteristics with 2D and 3D US. RESULTS 3D imaging was successfully performed in 45 of the 50 cases and the technical success rate was 90%. A single plaque was detected in 64.4% of the patients, with the remaining 35.6% having more than one plaque. The lengths of the plaques ranged from 2 to 12 mm (mean: 3.98 ±1.70 mm); the widths ranged from 1.8 to 3.2 mm (mean: 2.11 ±0.37 mm). No significant difference was found between 2D and 3D plaque echo-structures (observer 1, p = 0.317; observer 2, p = 0.276), but there were significant differences between 2D and 3D plaque surface irregularities (observer 1, p = 0.002; observer 2, p = 0.004). The inter-observer agreement on 2D and 3D plaque echo-structure and surface irregularity was very good (k coefficients were 0.89 and 0.83, respectively, for echo-structure, and 0.91 and 0.95, respectively, for surface irregularity). CONCLUSIONS The present study shows that 3D US examination is a valuable non-invasive method for investigation of surface irregularity of carotid artery plaques.
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Affiliation(s)
- Hakan Artas
- Department of Radiology, Faculty of Medicine, Firat University, Elazığ, Turkey
| | - Izzet Okcesiz
- Department of Radiology, Faculty of Medicine, Firat University, Elazığ, Turkey
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8
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Rafailidis V, Chryssogonidis I, Grisan E, Xerras C, Cheimariotis GA, Tegos T, Rafailidis D, Sidhu PS, Charitanti-Kouridou A. Does Quantification of Carotid Plaque Surface Irregularities Better Detect Symptomatic Plaques Compared to the Subjective Classification? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3163-3171. [PMID: 31066924 DOI: 10.1002/jum.15017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/22/2019] [Accepted: 04/17/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate the interobserver agreement of color Doppler ultrasound (CDUS) and contrast-enhanced ultrasound (CEUS) for quantification of carotid plaque surface irregularities and to correlate objective and subjective measures with stroke occurrence. METHODS This work was an observational study involving 54 patients with 62 internal carotid artery or carotid bulb plaques (31 symptomatic) undergoing CDUS and CEUS between February 2016 and February 2018, with retrospective interpretation of prospectively acquired data. Plaques were included if causing moderate (50%-69%) or severe (70%-99%) stenosis based on velocity criteria, and their surface was classified as smooth, irregular, or ulcerated based on CEUS. The surface irregularities were quantified in the form of a surface irregularity index by 2 observers, based on CDUS and CEUS. The surface irregularity index was evaluated for interobserver agreement with CDUS and CEUS and correlated with the occurrence of stroke, as was the subjective characterization of the plaque surface. RESULTS Color Doppler ultrasound and CEUS showed good interobserver agreement (intraclass correlation coefficients, 0.979 and 0.952, respectively). Plaques were characterized as smooth in 30.6% of cases, irregular in 50%, and ulcerated in 19.4%. The subjective classification of the plaque surface did not correlate with stroke occurrence (P > .05, χ2 ). Surface irregularity index values were significantly higher for symptomatic plaques with both CDUS and CEUS (P < .05). CONCLUSIONS Color Doppler ultrasound and CEUS can quantify carotid plaque surface irregularities with good interobserver agreement. The resulting quantitative measure was significantly higher in symptomatic plaques, whereas the subjective characterization of plaque surface failed to differ between symptomatic and asymptomatic plaques.
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Affiliation(s)
- Vasileios Rafailidis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Chryssogonidis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Enrico Grisan
- Department of Information Engineering, University of Padova, Padova, Italy
- School of Imaging Sciences and Biomedical Engineering, King's College London, London, England
| | - Chrysostomos Xerras
- First Neurological Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Grigorios-Aris Cheimariotis
- Laboratory of Computing, Medical Informatics, and Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Tegos
- First Neurological Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Rafailidis
- Department of Radiology, G. Gennimatas General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, London, England
| | - Afroditi Charitanti-Kouridou
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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9
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Rafailidis V, Chryssogonidis I, Xerras C, Grisan E, Cheimariotis GA, Tegos T, Rafailidis D, Sidhu PS, Charitanti-Kouridou A. An Ultrasonographic Multiparametric Carotid Plaque Risk Index Associated with Cerebrovascular Symptomatology: A Study Comparing Color Doppler Imaging and Contrast-Enhanced Ultrasonography. AJNR Am J Neuroradiol 2019; 40:1022-1028. [PMID: 31072976 DOI: 10.3174/ajnr.a6056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/30/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Various ultrasonographic features of carortid plaques have been associated with the occurence of stroke, highlighting the need for multi-parametric assessment of plaque's vulnerability. Our aim was to compare ultrasonographic multiparametric indices using color Doppler imaging and contrast-enhanced sonography between symptomatic and asymptomatic carotid plaques. MATERIALS AND METHODS This was a cross-sectional observational study recruiting 54 patients (72.2% male; median age, 61 years) undergoing sonography and contrast-enhanced sonography. Patients were included if a moderately or severely stenotic internal carotid artery plaque was detected, with the plaque being considered symptomatic if it was ipsilateral to a stroke occuring within the last 6 months. A vulnerability index, previously described by Kanber et al, combined the degree of stenosis, gray-scale median, and a quantitative measure of surface irregularities (surface irregularity index) derived from color Doppler imaging and contrast-enhanced ultrasonography, resulting in 2 vulnerability indices, depending on the surface irregularity index used. Mann-Whitney U and t tests were used to compare variables between groups, and receiver operating characteristic curves were used to compare diagnostic accuracy. RESULTS Sixty-two plaques were analyzed (50% symptomatic), with a mean degree of stenosis of 68.9%. Symptomatic plaques had a significantly higher degree of stenosis (mean, 74.7% versus 63.1%; P < .001), a lower gray-scale median (13 versus 38; P = .001), and a higher Kanber vulnerability index based both on color Doppler imaging (median, 61.4 versus 16.5; P < .001) and contrast-enhanced ultrasonography (median, 88.6 versus 25.2; P < .001). The area under the curve for the detection of symptomatic plaques was 0.772 for the degree of stenosis alone, 0.783 for the vulnerability index-color Doppler imaging, and 0.802 for the vulnerability index-contrast-enhanced ultrasonography, though no statistical significance was achieved. CONCLUSIONS Symptomatic plaques had a higher degree of stenosis, lower gray-scale median values, and higher values of the Kanber vulnerability index using both color Doppler imaging and contrast-enhanced ultrasonography for plaque surface delineation.
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Affiliation(s)
- V Rafailidis
- From the Department of Radiology (V.R., I.C., A.C.-K.)
| | | | - C Xerras
- First Department of Neurology (C.X., T.T.), AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Grisan
- Department of Information Engineering (E.G.), University of Padova, Padova, Italy.,School of Imaging Sciences and Biomedical Engineering (E.G.), King's College London, London, UK
| | - G-A Cheimariotis
- Laboratory of Computing (G.-A.C.), Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - T Tegos
- First Department of Neurology (C.X., T.T.), AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D Rafailidis
- Department of Radiology (D.R.), "G. Gennimatas" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - P S Sidhu
- Department of Radiology (P.S.S.), King's College Hospital, London, UK
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10
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Rafailidis V, Sidhu PS. Vascular ultrasound, the potential of integration of multiparametric ultrasound into routine clinical practice. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2018; 26:136-144. [PMID: 30147737 DOI: 10.1177/1742271x18762250] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 02/06/2018] [Indexed: 01/12/2023]
Abstract
Introduction Ultrasound has traditionally been regarded as the first-line imaging modality for screening, diagnostic evaluation and monitoring treatment and disease progression of vascular pathology, including both the arterial and the venous branch of the vascular system. Albeit of its well-tolerated nature, wide availability and low cost, ultrasound above all, has the advantage of providing the clinician with clinically significant information related to both intraluminal irregularities and extravascular disease. Ultrasound has the potential not only to anatomically describe tissues but also to assess physiology by evaluating blood flow characteristics in real time. Discussion The already fundamental role of ultrasound has been even more expanded with the introduction of newer techniques like contrast-enhanced ultrasound, tissue-elastography and 3D ultrasound and the incorporation of research advances into clinical practice. The purpose of this review is to present and discuss some of the latest advances in the field of vascular ultrasound in attempt to illustrate how the adoption of multiparametric ultrasound into everyday clinical practice could address the patient's needs. Pathology and applications discussed include carotid and aortic disease, portal and peripheral venous abnormalities. Conclusion Widespread availability of modern technology in ultrasound devices has made the application of contrast-enhanced ultrasound, tissue elastography and 3D ultrasound feasible options, ready to contribute to the diagnostic performance of the ultrasonographic technique.
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Affiliation(s)
- Vasileios Rafailidis
- Department of Radiology, King's College London, King's College Hospital, London, England, UK
| | - Paul S Sidhu
- Department of Radiology, King's College London, King's College Hospital, London, England, UK
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11
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Moroni F, Magnoni M, Vergani V, Ammirati E, Camici PG. Fractal analysis of plaque border, a novel method for the quantification of atherosclerotic plaque contour irregularity, is associated with pro-atherogenic plasma lipid profile in subjects with non-obstructive carotid stenoses. PLoS One 2018; 13:e0192600. [PMID: 29432486 PMCID: PMC5809053 DOI: 10.1371/journal.pone.0192600] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/28/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND AIMS Plaque border irregularity is a known imaging characteristic of vulnerable plaques, but its evaluation heavily relies on subjective evaluation and operator expertise. Aim of the present work is to propose a novel fractal-analysis based method for the quantification of atherosclerotic plaque border irregularity and assess its relation with cardiovascular risk factors. METHODS AND RESULTS Forty-two asymptomatic subjects with carotid stenosis underwent ultrasound evaluation and assessment of cardiovascular risk factors. Total, low-density lipoprotein (LDL), high-density lipoprotein (HDL) plasma cholesterol and triglycerides concentrations were measured for each subject. Fractal analysis was performed in all the carotid segments affected by atherosclerosis, i.e. 147 segments. The resulting fractal dimension (FD) is a measure of irregularity of plaque profile on long axis view of the plaque. FD in the severest stenosis (main plaque FD,mFD) was 1.136±0.039. Average FD per patient (global FD,gFD) was 1.145±0.039. FD was independent of other plaque characteristics. mFD significantly correlated with plasma HDL (r = -0.367,p = 0.02) and triglycerides-to-HDL ratio (r = 0.480,p = 0.002). CONCLUSIONS Fractal analysis is a novel, readily available, reproducible and inexpensive technique for the quantitative measurement of plaque irregularity. The correlation between low HDL levels and plaque FD suggests a role for HDL in the acquisition of morphologic features of plaque instability. Further studies are needed to validate the prognostic value of fractal analysis in carotid plaques evaluation.
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Affiliation(s)
- Francesco Moroni
- Cardiothoracic and Vascular Department, Vita-Salute University and San Raffaele Hospital, Milan, Italy
| | - Marco Magnoni
- Cardiothoracic and Vascular Department, Vita-Salute University and San Raffaele Hospital, Milan, Italy
| | - Vittoria Vergani
- Cardiothoracic and Vascular Department, Vita-Salute University and San Raffaele Hospital, Milan, Italy
| | - Enrico Ammirati
- Cardiothoracic and Vascular Department, Vita-Salute University and San Raffaele Hospital, Milan, Italy.,De Gasperis Cardio Center, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Paolo G Camici
- Cardiothoracic and Vascular Department, Vita-Salute University and San Raffaele Hospital, Milan, Italy
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Johri AM, Herr JE, Li TY, Yau O, Nambi V. Novel Ultrasound Methods to Investigate Carotid Artery Plaque Vulnerability. J Am Soc Echocardiogr 2017; 30:139-148. [DOI: 10.1016/j.echo.2016.11.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Indexed: 11/17/2022]
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Mitchell CC, Stein JH, Cook TD, Salamat S, Wang X, Varghese T, Jackson DC, Sandoval Garcia C, Wilbrand SM, Dempsey RJ. Histopathologic Validation of Grayscale Carotid Plaque Characteristics Related to Plaque Vulnerability. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:129-137. [PMID: 27720278 PMCID: PMC5327497 DOI: 10.1016/j.ultrasmedbio.2016.08.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 05/03/2023]
Abstract
Inflammation and angiogenesis play major roles in carotid plaque vulnerability. The purpose of this study was to determine whether gray-scale features of carotid plaques are associated with histologic markers for inflammation. Thirty-eight individuals completed a dedicated research carotid ultrasound exam before carotid endarterectomy. Gray-scale analysis was performed on plaque images to measure plaque echogenicity (gray-scale median [GSM] pixel brightness), plaque area, presence of discrete white areas (DWAs) and the percent of black area near the lumen on any one component of the plaque. Plaques with higher ultrasound GSM had greater percent calcification (p = 0.013) on histopathology. Presence of an ultrasound DWA was associated with more plaque hemosiderin (p = 0.0005) and inflammation (p = 0.019) on histopathology examination. The percent of plaque black area in any one component was associated with a higher score for macroscopic ulceration (p = 0.028). Ultrasound plaque characteristics (GSM, DWAs and black areas) represent histopathologic markers associated with plaque vulnerability. ClinicalTrials.gov identifier: NCT02476396.
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Affiliation(s)
- Carol C Mitchell
- Cardiovascular Medicine Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - James H Stein
- Cardiovascular Medicine Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Thomas D Cook
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Shahriar Salamat
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Xiao Wang
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Tomy Varghese
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daren C Jackson
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Carolina Sandoval Garcia
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Stephanie M Wilbrand
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Robert J Dempsey
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Widman E, Caidahl K, Heyde B, D'hooge J, Larsson M. Ultrasound speckle tracking strain estimation of in vivo carotid artery plaque with in vitro sonomicrometry validation. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:77-88. [PMID: 25308946 DOI: 10.1016/j.ultrasmedbio.2014.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/03/2014] [Accepted: 06/23/2014] [Indexed: 06/04/2023]
Abstract
Our objective was to validate a previously developed speckle tracking (ST) algorithm to assess strain in common carotid artery plaques. Radial and longitudinal strain was measured in common carotid artery gel phantoms with a plaque-mimicking inclusion using an in-house ST algorithm and sonomicrometry. Moreover, plaque strain by ST for seven patients (77 ± 6 y) with carotid atherosclerosis was compared with a quantitative visual assessment by two experienced physicians. In vitro, good correlation existed between ST and sonomicrometry peak strains, both radially (r = 0.96, p < 0.001) and longitudinally (r = 0.75, p < 0.01). In vivo, greater pulse pressure-adjusted radial and longitudinal strains were found in echolucent plaques than in echogenic plaques. This illustrates the feasibility of ultrasound ST strain estimation in plaques and the possibility of characterizing plaques using ST strain in vivo.
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Affiliation(s)
- Erik Widman
- Department of Medical Engineering, School of Technology and Health, KTH Royal Institute of Technology, Stockholm, Sweden.
| | - Kenneth Caidahl
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Brecht Heyde
- Cardiovascular Imaging & Dynamics, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Jan D'hooge
- Cardiovascular Imaging & Dynamics, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Matilda Larsson
- Department of Medical Engineering, School of Technology and Health, KTH Royal Institute of Technology, Stockholm, Sweden; Cardiovascular Imaging & Dynamics, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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Ramnarine KV, Garrard JW, Kanber B, Nduwayo S, Hartshorne TC, Robinson TG. Shear wave elastography imaging of carotid plaques: feasible, reproducible and of clinical potential. Cardiovasc Ultrasound 2014; 12:49. [PMID: 25487290 PMCID: PMC4293004 DOI: 10.1186/1476-7120-12-49] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 11/26/2014] [Indexed: 12/24/2022] Open
Abstract
Background Shear Wave Elastography (SWE) imaging is a novel ultrasound technique for quantifying tissue elasticity. Studies have demonstrated that SWE is able to differentiate between diseased and normal tissue in a wide range clinical applications. However its applicability to atherosclerotic carotid disease has not been established. The aim of this study was to assess the feasibility and potential clinical benefit of using SWE imaging for the assessment of carotid plaques. Methods Eighty-one patients (mean age 76 years, 51 male) underwent greyscale and SWE imaging. Elasticity was quantified by measuring mean Young’s Modulus (YM) within the plaque and within the vessel wall. Echogenicity was assessed using the Gray-Weale classification scale and the greyscale median (GSM). Results Fifty four plaques with stenosis greater than 30% were assessed. Reproducibility of YM measurements, quantified by the inter-frame coefficient of variation, was 22% within the vessel wall and 19% within the carotid plaque. Correlation with percentage stenosis was significant for plaque YM (p = 0.003), but insignificant for plaque GSM (p = 0.46). Plaques associated with focal neurological symptoms had significantly lower mean YM than plaques in asymptomatic patients (62 kPa vs 88 kPa; p = 0.01). Logistic regression and Receiver Operating Characteristic (ROC) analysis showed improvements in sensitivity and specificity when percentage stenosis was combined with the YM (area under ROC = 0.78). Conclusions Our study showed SWE is able to quantify carotid plaque elasticity and provide additional information that may be of clinical benefit to help identify the unstable carotid plaque. Electronic supplementary material The online version of this article (doi:10.1186/1476-7120-12-49) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kumar V Ramnarine
- Department of Medical Physics, University Hospitals of Leicester NHS Trust, Sandringham Building, Level 1, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW UK.
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Kanber B, Hartshorne TC, Horsfield MA, Naylor AR, Robinson TG, Ramnarine KV. Wall motion in the stenotic carotid artery: association with greyscale plaque characteristics, the degree of stenosis and cerebrovascular symptoms. Cardiovasc Ultrasound 2013; 11:37. [PMID: 24139162 PMCID: PMC3818684 DOI: 10.1186/1476-7120-11-37] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 10/04/2013] [Indexed: 11/23/2022] Open
Abstract
Background Systolic dilation of the atherosclerotic carotid artery depends on several factors including arterial compliance and the haemodynamic environment. The purpose of this study was to quantify wall motion in stenotic carotid arteries and investigate any associations with the ultrasound greyscale plaque characteristics, the degree of stenosis, and the presence of cerebrovascular symptoms. Methods Variations in the lumen diameters of 61 stenotic carotid arteries (stenosis range 10%-95%) from 47 patients were measured before the proximal shoulder of the atherosclerotic plaque using ultrasound image sequences over several cardiac cycles. Absolute and percentage diameter changes from diastole to systole were calculated and their relationship to the degree of stenosis, greyscale plaque characteristics, and the presence of ipsilateral hemispheric symptoms were studied. Results The mean absolute diameter change from diastole to systole was 0.45 mm (s.d. 0.17), and the mean percentage diameter change was 6.9% (s.d. 3.1%). Absolute and percentage diameter changes did not have a statistically significant relationship to the degree of stenosis, greyscale plaque characteristics, or the presence of ipsilateral hemispheric symptoms (p > 0.05). Parameters significantly correlated with the presence of symptoms were the degree of stenosis (p = 0.01), plaque greyscale median (p = 0.02) and the plaque surface irregularity index (p = 0.02). Conclusions Our study confirmed the degree of stenosis, plaque greyscale median and our surface irregularity index were significant predictors of symptoms, but found no significant correlation between diameter changes of stenosed carotid arteries and the presence of ipsilateral hemispheric symptoms.
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Affiliation(s)
| | | | | | | | | | - Kumar V Ramnarine
- Department of Medical Physics, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW UK.
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