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Dong Z, Zhao Y, Chen Y, Liu Z, Song H, Li H, Shi D, Zhou C, Zhou J, Liu R. Evaluating Atherosclerosis of the Abdominal Aorta in Rabbits Using 2-D Strain Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2199-2206. [PMID: 35953348 DOI: 10.1016/j.ultrasmedbio.2022.05.029] [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: 02/02/2022] [Revised: 05/05/2022] [Accepted: 05/22/2022] [Indexed: 06/15/2023]
Abstract
After establishment of an animal model of atherosclerosis, speckle tracking imaging was performed to analyze the correlation between ultrasound characteristics and pathological manifestations. Rabbits were divided into the normal control (NC) and atherosclerosis (AS) groups. Rabbits in the AS group were subjected to ultrasound-guided balloon injury of the abdominal aorta and fed a high-fat diet for 16 wk. Rabbits in the NC group were fed a normal diet for the same period. After 16 wk, all animals underwent serological tests, ultrasound and speckle tracking circumferential strain analysis. In the AS group, 28 hypo-echoic plaques had formed. The circumferential strain of six segments at the short axis of plaques in the AS group was lower than that in the NC group (p < 0.001), and global circumferential strain (GCS) in the AS group was significantly reduced compared with the NC group (p < 0.001). In the AS group, the area ratio of type I to type III collagen fibers was smaller than that in the NC group. The GCS of atherosclerotic plaques was positively correlated with the area ratio of type I to type III collagen fibers in plaques (r = 0.7181, p < 0.001). In conclusion, there is a significant positive correlation between the decreased circumferential strain and the decreased area ratio of type I to type III collagen fibers in hypo-echoic plaques.
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Affiliation(s)
- Zhizhi Dong
- Department of Ultrasound, First College of Clinical Medical Sciences, China Three Gorges University & Yichang Central People's Hospital, Yichang, China; Central Laboratory, First College of Clinical Medical Science, China Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Yun Zhao
- Medical College of China Three Gorges University, Yichang, China
| | - Yue Chen
- Department of Ultrasound, First College of Clinical Medical Sciences, China Three Gorges University & Yichang Central People's Hospital, Yichang, China; Central Laboratory, First College of Clinical Medical Science, China Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Zulin Liu
- Department of Ultrasound, First College of Clinical Medical Sciences, China Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Haiying Song
- Department of Ultrasound, First College of Clinical Medical Sciences, China Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Hao Li
- Department of Gastrointestinal Surgery, First College of Clinical Medical Sciences, China Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Douzi Shi
- Department of Ultrasound, First College of Clinical Medical Sciences, China Three Gorges University & Yichang Central People's Hospital, Yichang, China; Central Laboratory, First College of Clinical Medical Science, China Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Chang Zhou
- Department of Ultrasound, First College of Clinical Medical Sciences, China Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Jun Zhou
- Department of Ultrasound, First College of Clinical Medical Sciences, China Three Gorges University & Yichang Central People's Hospital, Yichang, China
| | - Rong Liu
- Department of Ultrasound, First College of Clinical Medical Sciences, China Three Gorges University & Yichang Central People's Hospital, Yichang, China.
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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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Sultan SR, Bashmail FT, Alzahrani NA, Alharbi SI, Anbar R, Alkharaiji M. Contrast-enhanced ultrasound for the evaluation of symptomatic and asymptomatic carotid plaques: A systematic review and meta-analysis. Echocardiography 2022; 39:1032-1043. [PMID: 35768892 DOI: 10.1111/echo.15407] [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: 02/14/2022] [Revised: 04/22/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) is a promising imaging modality for the assessment of plaque vulnerability. We aimed to systematically review and meta-analyze the ability of CEUS parameters to differentiate between symptomatic and asymptomatic carotid plaques and to assess its reproducibility. METHODS PubMed, EMBASE, and Cochrane Library databases were searched for studies that potentially evaluated carotid plaques using CEUS. From the initial 2870 searches, 11 relevant publications comprising a total of 821 carotid plaques were reviewed. Data on CEUS parameters including quantitative and semi-quantitative parameters were extracted and analyzed. RESULTS The overall analysis showed significantly higher CEUS parameters in symptomatic carotid plaques compared to asymptomatic carotid plaques (standardised mean difference (SMD) .95, 95% confidence interval (CI) .56-1.27, p < .01). Intra and inter-observer reproducibility of quantitative CEUS parameters were excellent (intra-observer, r = .95, 95% CI .87-1; inter-observer, r = .93, 95% CI .80-.1). Semi-quantitative CEUS parameters showed good intra-observer reliability and moderate inter-observer reliability (intra-observer, r = .77, 95% CI .64-.89; inter-observer, r = .75, 95% CI .61-.89). Heterogeneity among studies compared CEUS parameters in symptomatic and asymptomatic plaques and studies assessed inter-observer reproducibility, and significant biases in studies assessing CEUS reproducibility were present. CONCLUSION CEUS is a useful vascular imaging method to differentiate between symptomatic and asymptomatic carotid plaques with moderate to excellent reproducibility. Quantitative CEUS analysis appeared to be more sensitive and reliable in assessing carotid plaques than semi-quantitative parameters. Further longitudinal prospective trials evaluating carotid plaque in asymptomatic population using CEUS to determine plaque characteristics that can become symptomatic are required.
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Affiliation(s)
- Salahaden R Sultan
- Department of Radiologic Sciences, College of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fatima T Bashmail
- Department of Radiologic Sciences, College of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nouf A Alzahrani
- Department of Radiologic Sciences, College of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Shahd I Alharbi
- Department of Radiologic Sciences, College of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rayan Anbar
- Department of Radiologic Sciences, College of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Alkharaiji
- Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
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Saba L, Antignani PL, Gupta A, Cau R, Paraskevas KI, Poredos P, Wasserman B, Kamel H, Avgerinos ED, Salgado R, Caobelli F, Aluigi L, Savastano L, Brown M, Hatsukami T, Hussein E, Suri JS, Mansilha A, Wintermark M, Staub D, Montequin JF, Rodriguez RTT, Balu N, Pitha J, Kooi ME, Lal BK, Spence JD, Lanzino G, Marcus HS, Mancini M, Chaturvedi S, Blinc A. International Union of Angiology (IUA) consensus paper on imaging strategies in atherosclerotic carotid artery imaging: From basic strategies to advanced approaches. Atherosclerosis 2022; 354:23-40. [DOI: 10.1016/j.atherosclerosis.2022.06.1014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 12/24/2022]
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Golemati S, Yanni A, Tsiaparas NN, Lechareas S, Vlachos IS, Cokkinos DD, Krokidis M, Nikita KS, Perrea D, Chatziioannou A. CurveletTransform-Based Texture Analysis of Carotid B-mode Ultrasound Images in Asymptomatic Men With Moderate and Severe Stenoses: A Preliminary Clinical Study. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:78-90. [PMID: 34666918 DOI: 10.1016/j.ultrasmedbio.2021.09.005] [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: 12/14/2020] [Revised: 09/02/2021] [Accepted: 09/04/2021] [Indexed: 06/13/2023]
Abstract
The curvelet transform, which represents images in terms of their geometric and textural characteristics, was investigated toward revealing differences between moderate (50%-69%, n = 11) and severe (70%-100%, n = 14) stenosis asymptomatic plaque from B-mode ultrasound. Texture features were estimated in original and curvelet transformed images of atheromatous plaque (PL), the adjacent arterial wall (intima-media [IM]) and the plaque shoulder (SH) (i.e., the boundary between plaque and wall), separately at end systole and end diastole. Seventeen features derived from the original images were significantly different between the two groups (4 for IM, 3 for PL and 10 for SH; 9 for end diastole and 8 for end systole); 19 of 234 features (2 for IM and 17 for SH; 8 for end systole and 11 for end diastole) derived from curvelet transformed images were significantly higher in the patients with severe stenosis, indicating higher magnitude, variation and randomness of image gray levels. In these patients, lower body height and higher serum creatinine concentration were observed. Our findings suggest that (a) moderate and severe plaque have similar curvelet-based texture properties, and (b) IM and SH provide useful information about arterial wall pathophysiology, complementary to PL itself. The curvelet transform is promising for identifying novel indices of cardiovascular risk and warrants further investigation in larger cohorts.
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Affiliation(s)
- Spyretta Golemati
- Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Amalia Yanni
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - Nikolaos N Tsiaparas
- Biomedical Simulations and Imaging Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Symeon Lechareas
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis S Vlachos
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Miltiadis Krokidis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina S Nikita
- Biomedical Simulations and Imaging Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Despina Perrea
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Sztajzel RF, Engelter ST, Bonati LH, Mono M, Slezak A, Kurmann R, Nedeltchev K, Gensicke H, Traenka C, Baumgartner RW, Bonvin C, Hirt L, Medlin F, Burow A, Kägi G, Kapauer M, Vehoff J, Lovblad KO, Curtin F, Lyrer PA. Carotid plaque surface echogenicity predicts cerebrovascular events: An Echographic Multicentric Swiss Study. J Neuroimaging 2022; 32:1142-1152. [PMID: 35848388 PMCID: PMC9796934 DOI: 10.1111/jon.13026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 06/24/2022] [Accepted: 07/06/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND PURPOSE To determine the prognostic value for ischemic stroke or transitory ischemic attack (TIA) of plaque surface echogenicity alone or combined to degree of stenosis in a Swiss multicenter cohort METHODS: Patients with ≥60% asymptomatic or ≥50% symptomatic carotid stenosis were included. Grey-scale based colour mapping was obtained of the whole plaque and of its surface defined as the regions between the lumen and respectively 0-0.5, 0-1, 0-1.5, and 0-2 mm of the outer border of the plaque. Red, yellow and green colour represented low, intermediate or high echogenicity. Proportion of red color on surface (PRCS) reflecting low echogenictiy was considered alone or combined to degree of stenosis (Risk index, RI). RESULTS We included 205 asymptomatic and 54 symptomatic patients. During follow-up (median/mean 24/27.7 months) 27 patients experienced stroke or TIA. In the asymptomatic group, RI ≥0.25 and PRCS ≥79% predicted stroke or TIA with a hazard ratio (HR) of respectively 8.7 p = 0.0001 and 10.2 p < 0.0001. In the symptomatic group RI ≥0.25 and PRCS ≥81% predicted stroke or TIA occurrence with a HR of respectively 6.1 p = 0.006 and 8.9 p = 0.001. The best surface parameter was located at 0-0.5mm. Among variables including age, sex, degree of stenosis, stenosis progression, RI, PRCS, grey median scale values and clinical baseline status, only PRCS independently prognosticated stroke (p = 0.005). CONCLUSION In this pilot study including patients with at least moderate degree of carotid stenosis, PRCS (0-0.5mm) alone or combined to degree of stenosis strongly predicted occurrence of subsequent cerebrovascular events.
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Affiliation(s)
- Roman F Sztajzel
- Department of Neurology and Stroke CenterUniversity Hospital Geneva and Medical School
| | - Stefan T Engelter
- University of Basel,Neurorehabilitation Unit University of Basel and University Center for Medicine of Aging and Rehabilitation
| | | | | | | | | | | | | | | | | | - Christophe Bonvin
- Department of Neurology and Stroke CenterUniversity Hospital Geneva and Medical School
| | | | | | | | - Georg Kägi
- Department of NeurologyCantonal Hospital and Stroke CenterSt. Gallen
| | - Monika Kapauer
- Department of NeurologyCantonal Hospital and Stroke CenterSt. Gallen
| | - Jochen Vehoff
- Department of NeurologyCantonal Hospital and Stroke CenterSt. Gallen
| | - Karl O Lovblad
- University Hospital Geneva and Medical School and Department of Neuroradiology
| | - Francois Curtin
- Felix Platter Hospital, Basel, Department of Clinical PharmacologyUniversity Hospital Geneva
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Correlation between serum uric acid levels and carotid plaque neovascularisation assessed by contrast-enhanced ultrasound. Clin Radiol 2021; 76:942.e1-942.e6. [PMID: 34482988 DOI: 10.1016/j.crad.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/03/2021] [Indexed: 11/21/2022]
Abstract
AIM To investigate the potential impact of serum uric acid (SUA) levels on the grade of intraplaque neovascularisation (IPN) at contrast-enhanced ultrasound (CEUS). MATERIAL AND METHODS The study screened 212 patients with carotid atherosclerotic plaques using conventional ultrasound, and the patients then underwent CEUS. Based on the distribution of contrast medium microbubbles in the plaque, patients were split into three groups: 60 patients regarded as grade 0-1 (group A), 81 patients as grade 2 (group B), and 71 patients as grade 3 (group C), and SUA levels were measured on the second day after CEUS. RESULTS The frequencies of stroke were statistically different between the three groups (p<0.05). In grades 0, 1, 2, and 3, SUA levels ranged from 236.92 ± 72.75, 276.46 ± 67.31, 283.93 ± 53.85, and 384.49 ± 79.80 μmol/l, respectively. Spearman's analysis showed that the visual grade of IPN at CEUS correlated linearly with the SUA level (r=0.551, p<0.01). The difference in SUA levels between different sexes was statistically significant (p<0.05), and the differences in plaque echogenicity and diastolic blood pressure (DBP) between the three groups were also statistically significant (all p<0.05). CONCLUSIONS SUA levels correlate positively with the visual grade of IPN at CEUS, which may promote plaque vulnerability. The present results may further help to optimise therapy for vulnerable plaque and improve stroke risk stratification strategies.
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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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