Carotid Contrast-enhanced Ultrasound Research Articles

Correlation of enhancement degree on contrast-enhanced ultrasound with histopathology of carotid plaques and serum high sensitive C-reactive protein levels in patients undergoing carotid endarterectomy.

This study was undertaken to investigate the correlation of the enhancement degree on contrast-enhanced ultrasound (CEUS) with the histopathology of carotid plaques and the serum high sensitive C-reactive protein (hs-CRP) levels in patients undergoing carotid endarterectomy (CEA). Carotid CEUS was performed preoperatively in 115 patients who would undergo CEA, and the enhancement degree of the carotid plaques was evaluated by both the visual semiquantitative analysis and the quantitative time-intensity curve analysis. Serum hs-CRP levels were detected using the particle-enhanced immunoturbidimetric assay also before the operation. Additionally, the carotid plaque samples were subjected to histopathological examination postoperatively. The density of neovessels and the number of macrophages in the plaques were assessed by immunohistochemistry. The results showed that among the 115 patients, grade 0 plaque contrast enhancement was noted in 35 patients, grade 1 in 48 patients and grade 2 in 32 patients. The degree of plaque enhancement, the density of neovessels, the number of macrophages, and the hs-CRP levels were highest in the grade 2 patients. Correlation analysis showed that the enhancement degree of the carotid plaques was closely related to the immunohistochemical parameters of the plaques and the serum hs-CRP levels. It was suggested that the carotid plaque enhancement on CEUS can be used to evaluate the vulnerability of carotid plaques.

Application of contrast enhanced ultrasound in the diagnosis of carotid plaque characteristics: comparison with magnetic resonance angiography

Objective To compare the application value of contrast enhanced ultrasound (CEUS) and contrast enhanced magnetic resonance angiography (CEMRA) in the diagnosis of carotid plaque characteristics. Methods Fourty-six patients (48 carotid plaques) were performed with carotid CEUS and CEMRA examination prior to carotid endarterectomy. The following characteristics of plaque including the surface of the plaque,the presence of calcification,the internal composition and the diameter stenosis were observed and measured,which were compared with pathologic and digital subtraction angiography(DSA) results. Results There were 42 vulnerable plaques and 6 stable plaques in the 48 plaques. Fourty-seven carotid plaques had been correctly diagnosed by CEUS and CEMRA,and one plaque had been misdiagnosed. The sensitivity,specificity and accuracy between CEUS and CEMRA had no obvious differences in terms of the overall evaluation of plaque vulnerability (P>0.05); CEUS and CEMRA in the diagnosion of the plaque surface situation had no statistical difference in terms of sensitivity,specificity and accuracy compared with pathological results(P>0.05); There was no significant difference in diagnostic accuracy rate between two modalities (P 0.05). With DSA examination results as the gold standard,the accuracy of CEUS in the diagnosis of the diameter stenosis was 97.92% (47/48),CEMRA was 100% (48/48),they had no significant difference between two groups (P>0.05). Conclusions CEUS and CEMRA in carotid plaques characteristic evaluation have respective advantages,are highly complementary,and combining two methods can systematically evaluate for plaque characteristics. Key words: Ultrasonography; Magnetic resonance angiography; Carotid artery diseases; Plaque

Contrast-Enhanced Ultrasound of the Carotid Artery in Patients With Large Vessel Vasculitis: Correlation With Positron Emission Tomography Findings.

To assess the findings of contrast-enhanced ultrasound (CEUS) of carotid arteries in patients with large vessel vasculitis (LVV) and to compare them with those observed using 18 F-fluorodeoxyglucose-positron emission tomography (18 FDG-PET). A total of 31 consecutive patients with LVV (14 with Takayasu arteritis, 17 with giant cell arteritis with large vessel involvement) underwent both PET/computed tomography and carotid artery color Doppler ultrasound (CDUS) for a total of 35 combined assessments. Right carotid artery CEUS was performed after CDUS in all assessments. Kerr's criteria, a complete clinical examination, and acute phase reactants were simultaneously evaluated. The intensity of vascular uptake and vascularization of the carotid artery wall were compared. Ten 18 F-FDG/PET scans showed active vascular 18 F-FDG uptake (visual grade ≥2) in the right carotid artery. CEUS demonstrated severe vascularization (grade 2) within the right carotid artery wall in 12 examinations. The carotid CEUS vascularization grade significantly correlated with vascular 18 F-FDG uptake (P < 0.001) and maximum standardized uptake value (SUV) in the right carotid artery/mean SUV in the superior vena cava (P = 0.001). When active vascular 18 F-FDG uptake (≥2) was considered the gold standard for defining vascular inflammation, carotid CEUS had a sensitivity of 100% (95% confidence interval [95% CI] 65-100) and a specificity of 92% (95% CI 72-99). The positive likelihood ratio was 12.5 (95% CI 3.3-47.2). Severe vascularization at CEUS and active vascular 18 F-FDG uptake were significantly more frequent in active disease according to Kerr's criteria compared to inactive (P = 0.001 and P = 0.002, respectively). Carotid CEUS vascularization grade and the grade of vascular inflammation on 18 F-FDG-PET were correlated in patients with LVV.

2082582 Application of Carotid Contrast-Enhanced Ultrasound in Evaluation of Takayasu Arteritis and the Therapeutic Effect

2082582 Application of Carotid Contrast-Enhanced Ultrasound in Evaluation of Takayasu Arteritis and the Therapeutic Effect

Quantitative contrast-enhanced ultrasound of intraplaque neovascularization in patients with carotid atherosclerosis.

Intraplaque neovascularization (IPN) is an increasingly studied marker of the vulnerable atherosclerotic plaque, and contrast-enhanced ultrasound (CEUS) is an in vivo imaging technique for the assessment of IPN. The purpose of this study was to test novel quantification methods for the detection of carotid IPN using CEUS. 25 patients with established carotid atherosclerosis underwent bilateral carotid CEUS using a Philips iU-22 ultrasound system with an L9 - 3 transducer. Visual scoring of IPN was performed using a 3-point score. Quantification of IPN was performed using novel custom developed software. In short, regions of interest were drawn over the atherosclerotic plaques. After motion compensation, several IPN features were calculated. Statistical analysis was performed using Spearman's rho. Reproducibility of the quantification features was calculated using intra-class correlation coefficients and mean differences between calculations. 45 carotid arteries were available for the quantification of IPN. The quantification of IPN was feasible in all 45 carotid plaques. The IPN area, IPN area ratio and neovessel count had a good correlation with the visual IPN score (respectively ρ = 0.719, ρ = 0.538, ρ = 0.474 all p < 0.01). The intra-observer and inter-observer agreement was good to excellent (p < 0.01). The intra-observer and inter-observer variability was low. The quantification of carotid IPN on CEUS is feasible and provides multiple features on carotid IPN. Accurate quantitative assessment of IPN may be important to recognize and to monitor changes during therapy in vulnerable atherosclerotic plaques.

Impact of gender on the density of intraplaque neovascularization: A quantitative contrast-enhanced ultrasound study

ObjectiveAtherosclerosis is the main underlying cause of the majority of cardiovascular events. Although cardiovascular diseases (CVD) are a major challenge in both males and females, gender specific differences in the prevalence of CVD have been observed. This may indicate that there are differences in the development of atherosclerosis between males and females. The presence of intraplaque neovessels (IPN) is an imaging marker for plaque vulnerability. The aim of this study was to investigate the impact of gender on IPN. MethodsA total of 159 patients with ≥1 cardiovascular risk factor were included in this prospective study (mean age 56.9 ± 8.7 years, 47% females). Patients had no symptoms of carotid atherosclerotic disease. All patients underwent a standard carotid ultrasound examination in conjunction with contrast-enhanced ultrasound (CEUS). The presence of atherosclerotic plaques was assessed according to the Mannheim consensus. IPN was assessed using a visual grading scale and semi-automated quantification software. ResultsSubclinical atherosclerosis was detected using standard carotid ultrasound and CEUS in 64 females (86%) and in 79 males (93%) (p = 0.177). The mean atherosclerotic plaque sizes were not significantly different (p = 0.068). Semi-automated quantification of IPN demonstrated that females had significant more IPN compared to males (p < 0.05). After adjustment for clinical variables this association remained significant (p < 0.05). ConclusionIn this population at increased risk for CVD, females had significantly more IPN compared to males. This suggests that the females had a more vulnerable atherosclerotic plaque type.

Utility of contrast-enhanced ultrasound for the assessment of the carotid artery wall in patients with Takayasu or giant cell arteritis

Carotid contrast-enhanced ultrasound (CEUS) was recently proposed for the evaluation of large-vessel vasculitides (LVV), particularly to assess vascularization within the vessel wall. The aim of this pilot study was to evaluate the potential of carotid colour Doppler ultrasound (CDUS) and CEUS in patients with LVV. This prospective study included seven patients (mean age 48 ± 14 years, all females) with established LVV (Takayasu arteritis or giant cell arteritis). All patients underwent CDUS and CEUS (14 carotid arteries). Intima-media thickness, lumen diameter, Doppler velocities, vessel wall thickening, and lesion thickness were assessed. CEUS was used to improve visualization of the lumen-to-vessel wall border, and to visualize carotid wall vascularization. Four (57%) patients [7 (50%) carotid arteries] exhibited lesions, and the average lesion thickness was 2.0 ± 0.5 mm. According to the Doppler peak systolic velocity, 5 (35%) carotid arteries had a <50% stenosis, 1 (7%) had a 50-70% stenosis, and 1 (7%) had a ≥70% stenosis. The contrast agent improved the image quality and the definition of the lumen-to-vascular wall border. Carotid wall vascularization was observed in 5 (71%) patients [9 (64%) carotid arteries]. Five (36%) carotid arteries had mild-to-moderate vascularization, and 4 (29%) had severe wall vascularization. Carotid CDUS allows the assessment of anatomical features of LVV, including vessel wall thickening and degree of stenosis. Carotid CEUS improves the visualization of the lumen border, and allows dynamic assessment of carotid wall vascularization, which is a potential marker of disease activity in patients with LVV.

FRI0362 Contrast-enhanced ultrasound of the sovraortic arteries: the potential role in monitoring disease activity and response to treatment in large vessel vasculitis.

BackgroundPromising data has been recently published about the role of contrast-enhanced ultrasound (CEU) in the diagnosis and follow up of Takayasu arteritis (TA) -1,2-ObjectivesTo assess the role of CEU examination...

Use of Carotid Plaque Neovascularization at Contrast-enhanced US to Predict Coronary Events in Patients with Coronary Artery Disease

To determine whether carotid plaque neovascularization as assessed with contrast-enhanced ultrasonography (US) can help predict future coronary events in patients with stable coronary artery disease (CAD). The study was approved by the hospital ethics committee, and informed consent was obtained from all patients. Three hundred twelve consecutive patients (228 men; mean age, 63 years ± 9; age range, 42-88 years) with both CAD and at least one carotid plaque thicker than 2.0 mm underwent both standard and contrast-enhanced carotid US. Patients with stable CAD were followed up for 8-47 months (mean, 33 months ± 9) or until a coronary event occurred. Statistical analysis was performed with the Student t test, χ(2) analysis, Kaplan-Meier method, and Cox proportional hazards regression models. Contrast material enhancement of plaque was seen in 42 of 51 patients (82%) with acute coronary syndrome (ACS) and 114 of 261 patients (43.7%) with stable CAD (P < .001). Coronary events occurred during the follow-up period in 24 of 111 patients (21.6%) with contrast material enhancement of plaque and only seven of 137 patients (5.1%) without enhancement (P< .001). In 248 patients with stable CAD and follow-up, Kaplan-Meier analysis demonstrated a significantly higher probability of developing coronary events in patients with contrast material enhancement of plaque than in those without contrast material enhancement (P < .001). The presence of contrast material enhancement of plaque was a significant and independent predictor of future coronary events in patients with stable CAD (odds ratio: 3.90; 95% confidence interval: 1.60, 9.46; P = .003). Contrast material enhancement of plaque is more common in patients with ACS than in those with stable CAD and is a significant and independent predictor of future coronary events in patients with stable CAD, suggesting that noninvasive contrast-enhanced carotid US may be used as a method for risk stratification of patients with stable CAD.

Assessment of subclinical atherosclerosis using contrast-enhanced ultrasound

The sensitivity of standard carotid ultrasound and colour Doppler for the detection of subclinical atherosclerotic plaques is suboptimal. The aim of this study is to assess whether contrast-enhanced ultrasound (CEUS) added to standard carotid ultrasound improves the detection of subclinical atherosclerosis. Carotid intima-media thickness (CIMT) measurement, standard carotid ultrasound including colour Doppler imaging, and CEUS were performed in 100 asymptomatic patients with one or more risk factors for atherosclerosis. CEUS was performed using intravenous administration of SonoVue™ contrast agent (Bracco S.p.A., Milan, Italy). CIMT, standard ultrasound, colour Doppler, and CEUS were reviewed by two independent observers. Standard ultrasound, colour Doppler, and CEUS were scored for the presence of atherosclerotic plaques. Subclinical atherosclerosis was diagnosed if patients had a CIMT above their age-corrected threshold value or if atherosclerotic plaques were present on standard carotid ultrasound clips or CEUS clips. McNemar's test was performed to compare between groups. Twenty-one patients (21%) had a thickened CIMT value and were considered to have subclinical atherosclerosis. Standard carotid ultrasound including colour Doppler demonstrated atherosclerotic plaques in 77 patients (77%). The addition of CEUS to the standard ultrasound protocol demonstrated atherosclerotic plaques in 88 patients (88%). The incorporation of CEUS into the standard carotid ultrasound protocol resulted in a significantly improved detection of patients with subclinical atherosclerosis (P < 0.01). CEUS has an incremental value for the detection of subclinical atherosclerosis in the carotid arteries. Atherosclerotic plaques which were only detected with CEUS and not with standard carotid ultrasound and colour Doppler imaging were predominantly hypoechoic.

Plaque angiogenesis identification with Contrast Enhanced Carotid Ultrasonography: Statement of the Consensus after the 16th ESNCH Meeting – Munich, 20-23 May 2011

Contrast Enhanced Carotid Ultrasonography (CCU) is capable of detecting angiogenesis within the carotid plaque as a potential index of plaque vulnerability. However, due to a lack of standard of examination technique and documentation, results are not sufficiently, reliably comparable. To improve this situation and in order to support wide acceptance of this promising technique, experts in this field met in the Consensus conference in May 22, 2011, held during the 16th ESNCH Meeting (20–23 May 2011) in Munich, Germany, to discuss the limitations and problems and to determine guidelines for its proper use in scientific investigations and clinical practice. The main results of this conference are presented here. The discussion is still in progress and individual conclusions may not reflect the opinion of all participants. It aims to provide a basis for a later comprehensive consensus statement.

Abstract 9313: Contrast-Enhanced Ultrasound Imaging of Carotid Plaque Neovascularization is Useful for Identification of High-Risk Patients for Atherosclerotic Cardiovascular Diseases

Increased neovascularization in atherosclerotic plaques represents a feature of unstable plaques. Contrast-enhanced ultrasound (CEU) could be a potential technique for imaging plaque neovascularization in the carotid artery. This study examined whether CEU of the carotid artery may provide information of risk of cardiovascular diseases. Methods and Results: A total of 117 patients with CAD and a carotid plaque (IMT &gt; 1.1 mm) underwent CEU study of the carotid artery. The carotid CEU was performed using perfluorobutane microbubbles as an ultrasound contrast agent and harmonic imaging software. The intra-plaque neovascularization was identified based on the rapid movement of the echogenic reflectors of microbubbles within the plaque. The plaque neovascularization was graded: Grade (G) 0, no visible microbubbles within the plaque; G1, moderate microbubbles confined to plaque adventitial side and/or shoulder; G2, extensive microbubbles throughout the plaque. In a total of 252 plaques from the study patients, the G1 plaque neovascularization was noted in 51 plaques (20%) and G2 in 27 plaques (11%). Patients with higher grade of the plaque neovascularization had higher prevalence of smoking, older age, higher levels of LDL-C and HbA1c, higher systolic blood pressure, greater PWV and carotid IMT (p &lt; 0.05 in all). In logistic regression analysis, the G1/G2 plaque neovascularization was associated with acute coronary syndromes, multi-vessel coronary disease, chronic total coronary occlusions, ASO and previous stroke (OR 1.5, 2.0, 1.8, 2.2 and 1.6, 95% CI 1.2-2.5, 1.5-2.8, 1.1-3.1, 1.4-3.4 and 1.2-2.9, respectively, p &lt; 0.01 in all), that was independent of carotid IMT. The change in plaque neovascularization during 6 months was examined in a subgroup of 30 patients. Plaque neovascularization regressed in 16 ( 80%) of 20 plaques graded as G1/G2 of 16 patients taking statin, while the regression did not occur in any plaques in 14 patients taking no statin. The carotid IMT did not change in either patients with or without statin treatment. Conclusions: The contrast-enhanced ultrasound study of the carotid artery may provide valuable information for risk status of systemic atherosclerosis and for efficacy of anti-atherosclerotic treatment beyond carotid IMT.

Assessment of Takayasu Arteritis Activity by Carotid Contrast-Enhanced Ultrasound

A 35-year-old woman was admitted to our institute with a 5-year history of fatigue and low-grade fever. Six months before admission, she had pain in the neck and in the infrascapular region. On admission, the patient's heart rate was 80 bpm, her temperature was 37.3°C, and her blood pressure was 130/70 mm Hg in the right arm and 110/70 mm Hg in the left arm. Examination of the neck revealed no jugular venous distention but disclosed bilateral carotid murmurs. Cardiac examination revealed a regular rate and rhythm with a 3/6 holosystolic murmur audibled at the left sternal border. Lung fields were normal. Abdominal examination findings were normal, except for the presence of a palpable spleen and an abdominal bruit at the umbilical left lumbar region. Laboratory examination revealed hemoglobin, 8.5 g/dL (reference ranges, 12.0 to 15.5 g/dL); leukocytes, 21.7×109/L (3.5 to 10.5×109/L); platelets, 460×109/L (150 to 450×109/L); mean corpuscular volume, 76.0 fL (81.6 to 98.3 fL); erythrocyte sedimentation rate, 120 mm/h (0 to 20 mm/h); and …

Correlation of Carotid Plaque Neovascularization Detected by Using Contrast-enhanced US with Clinical Symptoms

To determine the correlation between the degree of plaque enhancement with contrast agent microbubbles and clinical symptoms in patients with carotid atherosclerotic plaque. The study was approved by the hospital ethical committee, and informed consent was obtained from all patients. One hundred four patients (83 men: mean age, 64 years +/- 9 [standard deviation]; 21 women: mean age, 61 years +/- 10) with carotid plaques were studied with standard and contrast material-enhanced ultrasonography (US). Contrast enhancement in the plaque was evaluated with visual interpretation and quantitative analysis. Among the 104 patients, 35 (34%) had transient ischemic attack and/or cerebrovascular ischemic stroke. Plaque enhancement was found in 28 (80%) of 35 symptomatic patients and in 21 (30%) of 69 asymptomatic patients (P < .001). Enhanced intensity in the plaque (13.9 dB +/- 6.4) and the ratio of enhanced intensity in the plaque to that in the lumen of the carotid artery (0.54 +/- 0.23) in symptomatic patients were significantly greater than those in asymptomatic patients (8.8 dB +/- 5.2 [P < .001] and 0.33 +/- 0.19 [P < .001], respectively). Sensitivity and specificity were 74% and 62%, respectively, for enhanced intensity in the plaque (cutoff value, 10.0 dB) and 74% and 75%, respectively, for ratio of enhanced intensity in the plaque to that in the lumen of the carotid artery (cutoff value, 0.46). Symptomatic patients had more intense contrast agent enhancement in the plaque than asymptomatic patients, suggesting that contrast-enhanced carotid US may be used for plaque risk stratification.

ソナゾイド造影頚動脈超音波検査による頚動脈プラーク内新生血管観察

ソナゾイド造影頚動脈超音波検査による頚動脈プラーク内新生血管観察