Abstract
BackgroundCarotid plaque echolucency as detected by Color Doppler ultrasonography (CDUS) has been used as a potential marker of plaque vulnerability. However, contrast-enhanced ultrasound (CEUS) has recently been shown to be a valuable method to evaluate the vulnerability and neovascularization within carotid atherosclerotic plaques. The aim of this study was to compare CEUS and CDUS in the assessment of plaque vulnerability using transcranial color Doppler (TCD) monitoring of microembolic signals (MES) as a reference technique.MethodsA total of 46 subjects with arterial stenosis (≥ 50%) underwent a carotid duplex ultrasound, TCD monitoring of MES and CEUS (SonoVue doses of 2.0 mL) within a span of 3 days. The agreement between the CEUS, CDUS, and MES findings was assessed with a chi-square test. A p-value less than 0.05 was considered statistically significant.ResultsNeovascularization was observed in 30 lesions (44.4%). The vascular risk factors for stroke were similar and there were no age or gender differences between the 2 groups. Using CEUS, MES were identified in 2 patients (12.5%) within class 1 (non-neovascularization) as opposed to 15 patients (50.0%) within class 2 (neovascularization) (p = 0.023). CDUS revealed no significant differences in the appearance of the MES between the 2 groups (hyperechoic and hypoechoic) (p = 0.237).ConclusionThis study provides preliminary evidence to suggest that intraplaque neovascularization detected by CEUS is associated with the presence of MESs, where as plaque echogenicity on traditional CDUS does not. These findings argue that CEUS may better identify high-risk plaques.
Highlights
Carotid plaque echolucency as detected by Color Doppler ultrasonography (CDUS) has been used as a potential marker of plaque vulnerability
microembolic signals (MES) were observed in 2 patients (12.5%) within class 1 and in 15 patients (50.0%) within class 2 (p = 0.0230) (Table 3, Figure 1)
No significant differences were observed in the appearance of the MES between the 2 groups (p = 0.2368) (Table 4)
Summary
Carotid plaque echolucency as detected by Color Doppler ultrasonography (CDUS) has been used as a potential marker of plaque vulnerability. Histological and imaging studies [1,2,3] have demonstrated that stroke is dependent on the degree of stenosis and the morphological features of the plaque, such as ulcers or fissures These morphological features can cause a rupture [4] of the plaque and recently several studies have confirmed the feasibility of using contrast-enhanced ultrasound (CEUS) for the evaluation of neovascularization within carotid atherosclerotic plaques. This technique may be used to assess the vulnerability of carotid plaques [8,9,10,11].
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