Plaque Borders Research Articles

RECURRENCE OF LEUKOPLAKIA IN LATERAL EDGE OF TONGUE: A CASE REPORT AFTER 8-YEARS OF CLINICAL FOLLOW-UP

Leukoplakia is a premalignant lesion. We report a 41-year-old female patient, who presented a painless white plaque with verrucous surface, in right lateral edge of tongue side, measuring 2 x 1 x 0.1 cm. Clinical hypothesis diagnosis was leukoplakia and a biopsy was performed. Histologic sections revealed a mucosal fragment covered by acanthotic hyper-orthokeratinized stratified squamous epithelium clinically compatible with leukoplakia. Since then, medical consultations have been held every 6 months. Special attention was paid to the years 2012 to 2019, when there was recurrence of the lesion, with dysplasia varying from mild to moderate and intense. The patient was referred to the head and neck surgeon for complete removal of the lesion. In 2019 follow-up another lesion appeared with white plaque, smooth surface, and clear borders, and the patient was again referred to the head and neck surgeon. This case illustrates the importance of clinical follow-up of premalignant lesions and its different behaviors to be determined for treatment.

Pseudocarcinomatous changes in giant porokeratosis of mibelli’: Histopathology as a valuable asset for early recognition of neoplastic changes – A case report with review

Porokeratosis is defined as a rare disorder of keratinization caused by clonal expansion of keratinocytes and characterized by an expanding thread-like border of hyperkeratotic plaques or papules with atrophic center. It is a genetically heterogeneous disorder that is mostly inherited as autosomal dominant trait. It is characterized histologically by the presence of a thin column of parakeratotic cells “cornoid lamella” representing the active border. This is a case report of a patient suffering from giant porokeratosis of Mibelli who developed secondary changes over the lesion in due course of time arousing suspicion of malignancy which turned out to be benign histopathologically. The risk factors for malignant changes are usually persistence of the lesion for long time, radiation therapy, long-term exposure to ultraviolet radiation, electron beam therapy, and immunosuppression associated with malignancies such as lymphoma, HIV infection, or due to immunomodulatory drugs.

Dual-energy CT imaging of orbits during episcleral brachytherapy with Ru-106 plaques: A phantom study on its potential for plaque position verification

PurposeTo investigate the potential of dual energy CT (DECT) to suppress metal artifacts and accurately depict episcleral brachytherapy Ru-106 plaques after surgical placement. MethodsAn anthropomorphic phantom simulating the adult head after surgical placement of a Ru-106 plaque was employed. Nine DECT acquisition protocols for orbital imaging were applied. Monochromatic 140 keV images were generated using iterative reconstruction and an available metal artifact reduction algorithm. Generated image datasets were graded by four observers regarding the ability to accurate demarcate the Ru-106 plaque. Objective image quality and visual grading analysis (VGA) was performed to compare different acquisition protocols. The DECT imaging protocol which allowed accurate plaque demarcation at minimum exposure was identified. The eye-lens dose from orbital DECT, with and without the use of radioprotective bismuth eye-shields, was determined using Monte Carlo methods. ResultsAll DECT acquisition protocols were judged to allow clear demarcation of the plaque borders despite some moderate streaking/shading artifacts. The differences between mean observers’ VGA scores for the 9 DECT imaging protocols were not statistically significant (p > 0.05). The eye-lens dose from the proposed low-exposure DECT protocol was found to be 20.1 and 22.8 mGy for the treated and the healthy eye, respectively. Bismuth shielding was found to accomplish >40% reduction in eye-lens dose without inducing shielding-related artifacts that obscure plaque delineation. ConclusionsDECT imaging of orbits after Ru-106 plaque positioning for ocular brachytherapy was found to allow artifact-free delineation of plaque margins at relatively low patient exposure, providing the potential for post-surgery plaque position verification.

Performance Assessment of K-Means and KNN Algorithm for the Detection of Borders and Extraction of Plaque Area from IVUS Images

The coronary artery vascular disease of atherosclerosis, which made the blood vessel artery wall harden and narrow. The vascular wall disease quantitatively analyzed and diagnosed by an intravascular ultrasound (IVUS) image. The quantitative investigations of coronary atherosclerosis by means of IVUS and manual recognition of wall and plaque borders are restricted by the need for observers with considerable understanding and the tedious environment of manual border detection. To improve and provide more detailed vessel and plaque information for better diagnosis and assessment go for an automated segmentation. An automated construction for the purpose of perceiving lumen and media-adventitia borders in IVUS images was effectively formulated. An effectual unsupervised K-Means clustering scheme refine the borders with morphological operations, later an IVUS data samples area classified using supervised KNN(K-Nearest Neighbor) classifier to extract the plaque feature. The performance of contour metric measurements in terms of Jaccard Index (JI), percentage area difference (PAD), area error (AE), dice index (DI), false positive ratio (RFP), in addition to false negative ratio (RFN) are computed for evaluation and variation.

TGFB1-Mediated Gliosis in Multiple Sclerosis Spinal Cords Is Favored by the Regionalized Expression of HOXA5 and the Age-Dependent Decline in Androgen Receptor Ligands.

In multiple sclerosis (MS) patients with a progressive form of the disease, spinal cord (SC) functions slowly deteriorate beyond age 40. We previously showed that in the SC of these patients, large areas of incomplete demyelination extend distance away from plaque borders and are characterized by a unique progliotic TGFB1 (Transforming Growth Factor Beta 1) genomic signature. Here, we attempted to determine whether region- and age-specific physiological parameters could promote the progression of SC periplaques in MS patients beyond age 40. An analysis of transcriptomics databases showed that, under physiological conditions, a set of 10 homeobox (HOX) genes are highly significantly overexpressed in the human SC as compared to distinct brain regions. Among these HOX genes, a survey of the human proteome showed that only HOXA5 encodes a protein which interacts with a member of the TGF-beta signaling pathway, namely SMAD1 (SMAD family member 1). Moreover, HOXA5 was previously found to promote the TGF-beta pathway. Interestingly, SMAD1 is also a protein partner of the androgen receptor (AR) and an unsupervised analysis of gene ontology terms indicates that the AR pathway antagonizes the TGF-beta/SMAD pathway. Retrieval of promoter analysis data further confirmed that AR negatively regulates the transcription of several members of the TGF-beta/SMAD pathway. On this basis, we propose that in progressive MS patients, the physiological SC overexpression of HOXA5 combined with the age-dependent decline in AR ligands may favor the slow progression of TGFB1-mediated gliosis. Potential therapeutic implications are discussed.

Levels of circulating soluble LR11, a regulator of smooth muscle cell migration, are highly associated with atherosclerotic plaques in patients with carotid artery stenosis

BackgroundThe levels of plasma sLR11, released from intimal SMCs, are positively associated with intima-media thickness (IMT) in asymptomatic subjects. We have evaluated the yet unknown pathological significance of sLR11 for plaque conditions in patients with carotid artery stenosis. MethodsThe presence of LR11 in carotid plaques was investigated using autopsy specimens. A clinical ultrasonography study for elucidating relationships between sLR11 and plaque condition was performed in 46 patients. ResultsImmunohistochemistry showed high levels of LR11 in SMCs within thickened intima and at the media-intima border of atherosclerotic carotid plaques. The levels of sLR11 in patients were clearly elevated compared to healthy controls. Univariate analysis of sLR11 revealed significant positive correlation with plaque score and a tendency to correlate with the stenotic fraction. Univariate and multiple regression analyses of plaque scores showed that sLR11, maximum IMT, and HDL-cholesterol independently determined plaque score. Finally, univariate analysis of initial sLR11 levels for changes in imaging markers after one-year follow-up showed that initial sLR11 levels significantly correlated with stenotic fraction progression. ConclusionsThe levels of sLR11, abundantly expressed in carotid atherosclerotic plaques, are highly associated with increased plaque score. sLR11 levels may be predictive of plaque conditions in patients with advanced carotid atherosclerosis.

Limited Macrophage Positional Dynamics in Progressing or Regressing Murine Atherosclerotic Plaques-Brief Report.

Objective- Macrophages play important roles in the pathogenesis of atherosclerosis, but their dynamics within plaques remain obscure. We aimed to quantify macrophage positional dynamics within progressing and regressing atherosclerotic plaques. Approach and Results- In a stable intravital preparation, large asymmetrical foamy macrophages in the intima of carotid artery plaques were sessile, but smaller rounded cells nearer plaque margins, possibly newly recruited monocytes, mobilized laterally along plaque borders. Thus, to test macrophage dynamics in plaques over a longer period of time in progressing and regressing disease, we quantified displacement of nondegradable phagocytic particles within macrophages for up to 6 weeks. In progressing plaques, macrophage-associated particles appeared to mobilize to deeper layers in plaque, whereas in regressing plaques, the label was persistently located near the lumen. By measuring the distance of the particles from the floor of the plaque, we discovered that particles remained at the same distance from the floor regardless of plaque progression or regression. The apparent deeper penetration of labeled cells in progressing conditions could be attributed to monocyte recruitment that generated new superficial layers of macrophages over the labeled phagocytes. Conclusions- Although there may be individual exceptions, as a population, newly differentiated macrophages fail to penetrate significantly deeper than the limited depth they reside on initial entry, regardless of plaque progression, or regression. These limited dynamics may prevent macrophages from escaping areas with unfavorable conditions (such as hypoxia) and pose a challenge for newly recruited macrophages to clear debris through efferocytosis deep within plaque.

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.

Background and aimsPlaque 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 resultsForty-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).ConclusionsFractal 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.

A Unique TGFB1-Driven Genomic Program Links Astrocytosis, Low-Grade Inflammation and Partial Demyelination in Spinal Cord Periplaques from Progressive Multiple Sclerosis Patients.

We previously reported that, in multiple sclerosis (MS) patients with a progressive form of the disease, spinal cord periplaques extend distance away from plaque borders and are characterized by the co-occurrence of partial demyelination, astrocytosis and low-grade inflammation. However, transcriptomic analyses did not allow providing a comprehensive view of molecular events in astrocytes vs. oligodendrocytes. Here, we re-assessed our transcriptomic data and performed co-expression analyses to characterize astrocyte vs. oligodendrocyte molecular signatures in periplaques. We identified an astrocytosis-related co-expression module whose central hub was the astrocyte gene Cx43/GJA1 (connexin-43, also named gap junction protein α-1). Such a module comprised GFAP (glial fibrillary acidic protein) and a unique set of transcripts forming a TGFB/SMAD1/SMAD2 (transforming growth factor β/SMAD family member 1/SMAD family member 2) genomic signature. Partial demyelination was characterized by a co-expression network whose central hub was the oligodendrocyte gene NDRG1 (N-myc downstream regulated 1), a gene previously shown to be specifically silenced in the normal-appearing white matter (NAWM) of MS patients. Surprisingly, besides myelin genes, the NDRG1 co-expression module comprised a highly significant number of translation/elongation-related genes. To identify a putative cause of NDRG1 downregulation in periplaques, we then sought to identify the cytokine/chemokine genes whose mRNA levels inversely correlated with those of NDRG1. Following this approach, we found five candidate immune-related genes whose upregulation associated with NDRG1 downregulation: TGFB1 (transforming growth factor β 1), PDGFC (platelet derived growth factor C), IL17D (interleukin 17D), IL33 (interleukin 33), and IL12A (interleukin 12A). From these results, we propose that, in the spinal cord periplaques of progressive MS patients, TGFB1 may limit acute inflammation but concurrently induce astrocytosis and an alteration of the translation/elongation of myelin genes in oligodendrocytes.

Cervical carotid plaque evaluation using 3D T1-weighted black-blood magnetic resonance imaging: Comparison of turbo field-echo and turbo spin-echo sequences

PurposeTo compare the capability of three-dimensional (3D) T1-weighted turbo field-echo (TFE) black-blood (BB) magnetic resonance imaging (MRI) and turbo-spin echo (TSE) BB MRI for discerning carotid plaques and the difference of signal intensities of the plaques from that of adjacent muscle in patients with cervical carotid stenosis. MethodsCervical carotid stenosis was evaluated by 3.0-T MR in 43 patients (38 men and 5 women; age, 36–83 years; mean age, 70 years) during 8 months. The carotid BB MRI comprised 3D T1-weighted TSE BB (T1-TSEBB) and 3D T1-weighted TFE BB (T1-TFEBB) sequences. The delineation of the carotid plaque border was evaluated in comparison with digital subtraction angiography (DSA). The border between the plaque and vessel lumen was rated visually (4-point analysis) and quantitatively (contrast-to-noise ratio). The signal-intensity ratio (SIR) of the plaque to the adjacent muscle was also measured. Data of 3D T1-TSEBB and 3D T1-TFEBB were compared statistically using the Wilcoxon signed-rank test. ResultsVisual and quantitative analyses revealed that the border between the plaque and vessel lumen was better delineated on 3D T1-TSEBB MRI than on 3D T1-TFEBB MRI (p<0.01, respectively). SIR of the plaque-to-adjacent muscle was higher on 3D T1- TFEBB MRI than on 3D T1-TSEBB MRI (p<0.05). High signal plaques with a SIR of >1.5 were underestimated on 3D T1-TSEBB MRI. Conclusions3D T1-TSEBB MRI was superior to 3D T1-TFEBB MRI for delineating carotid plaques; however, high signal plaques were underestimated on 3D T1-TSEBB MRI.

An integrated system for the complete segmentation of the common carotid artery bifurcation in ultrasound images

The complete segmentation of the common carotid artery (CCA) bifurcation in ultrasound images is important for the evaluation of atherosclerosis disease and the quantification of the risk of stroke. The current research work further evaluates and validates a semi-automated (SA) snake’s based segmentation system suitable for the complete segmentation of the CCA bifurcation in two-dimensional (2D) ultrasound images. The proposed system semi-automatically estimates the intima-media thickness (IMT), the atherosclerotic carotid plaque borders and dimensions, the internal carotid artery (ICA) origin’s stenosis, the carotid diameter (D), as well as other geometric measurements of the atherosclerotic carotid plaque. The system was evaluated on 300 2D longitudinal ultrasound images of the CCA bifurcation with manual (M) segmentations available from a neurovascular expert. No statistical significant differences between all M and SA IMT, plaque and D segmentation measurements were found. In a future study, texture features extracted from the intima-media complex (IMC) may be used to separate subjects in high and low risk groups, which may develop a stroke. However, a larger scale study is required for evaluating the system before its application in the real clinical practice.

Abstract 658: Macrophage Dynamics in Inflammation: Tree Ring--Like Growth of Macrophages in Layers Within Atherosclerotic Plaques

The mechanisms that control macrophage accumulation and retraction from plaques are fervently debated. We had earlier wondered if monocyte-derived cells might be driven to become motile cells resembling dendritic cells, capable of leaving plaque, under conditions when macrophage content in plaques waned. Thus, our laboratory developed a technique that allows the use of fluorescent phagocytic tracers to quantitatively monitor macrophage influx into plaques as well as the potential emigration of macrophages out of plaques. The phagocytic tracer was not removed from plaques when plaque macrophage content receded in conjunction with a stark lowering of plasma cholesterol, arguing that macrophage loss does not result from robust emigration of macrophages out of plaques. Nonetheless, here we show that the distribution of the phagocytic tracer was very different under conditions when macrophage content wanes, as the tracer is distributed near the arterial lumen in this case, versus conditions when macrophages increase, when the tracer is located deep within plaques. Under all conditions and time points, the tracer remained equidistant from the internal elastic lamina that defined the border of the inflammatory plaque, indicating that tracer-bearing macrophages underwent no net displacement. Indeed, we could generate a tree-ring like appearance in plaques by labeling a second wave of monocytes with fluorescent particles of a different color than the first and show that they created a second layer, resembling growth of rings on an aging tree. Preliminary data from multiphoton imaging in atherosclerotic plaques supports the concept of restricted territories for plaque macrophages following recruitment. Under conditions when monocyte recruitment continues, previously recruited macrophages that get buried would likely be subjected to increasing hypoxia and related signals that are pro-inflammatory. This layering of macrophages on macrophages may itself drive a vicious cycle that perpetuates inflammation beyond through signals other than the signal that initiated plaque development in the first place.

An integrated system for the segmentation of atherosclerotic carotid plaque ultrasound video

The robust border identification of atherosclerotic carotid plaque, the corresponding degree of stenosis of the common carotid artery (CCA), and also the characteristics of the arterial wall, including plaque size, composition, and elasticity, have significant clinical relevance for the assessment of future cardiovascular events. To facilitate the follow-up and analysis of the carotid stenosis in serial clinical investigations, we propose and evaluate an integrated system for the segmentation of atherosclerotic carotid plaque in ultrasound videos of the CCA based on video frame normalization, speckle reduction filtering, M-mode state-based identification, parametric active contours, and snake segmentation. Initially, the cardiac cycle in each video is identified and the video M-mode is generated, thus identifying systolic and diastolic states. The video is then segmented for a time period of at least one full cardiac cycle. The algorithm is initialized in the first video frame of the cardiac cycle, with human assistance if needed, and the moving atherosclerotic plaque borders are tracked and segmented in the subsequent frames. Two different initialization methods are investigated in which initial contours are estimated every 20 video frames. In the first initialization method, the initial snake contour is estimated using morphology operators; in the second initialization method, the Chan-Vese active contour model is used. The performance of the algorithm is evaluated on 43 real CCA digitized videos from B-mode longitudinal ultrasound segments and is compared with the manual segmentations of an expert, available every 20 frames in a time span of 3 to 5 s, covering, in general, 2 cardiac cycles. The segmentation results were very satisfactory, according to the expert objective evaluation, for the two different methods investigated, with true-negative fractions (TNF-specificity) of 83.7 ± 7.6% and 84.3 ± 7.5%; true-positive fractions (TPF-sensitivity) of 85.42 ± 8.1% and 86.1 ± 8.0%; and between the ground truth and the proposed segmentation method, kappa indices (KI) of 84.6% and 85.3% and overlap indices of 74.7% and 75.4%. The segmentation contours were also used to compute the cardiac state identification and radial, longitudinal, and shear strain indices for the CCA wall and plaque between the asymptomatic and symptomatic groups were investigated. The results of this study show that the integrated system investigated in this study can be successfully used for the automated video segmentation of the CCA plaque in ultrasound videos.

Porokeratosis ptychotropica: a rare variant of porokeratosis

Porokeratosis, a well recognized disorder of keratinization, is known to have several clinical variants. This report describes a rare variant characterized by verrucous plaques. An adult male presented with a slowly progressive verrucous plaque on the gluteal region that was resistant to conventional therapy. Careful inspection revealed a keratotic ridge at the plaque border leading to the diagnosis. Histopathology showed the presence of multiple cornoid lamellae confirming the diagnosis of porokeratosis ptychotropica. Porokeratosis ptychotropica is a rare variant of porokeratosis with fewer than 25 cases described in the literature. This report is to highlight the importance of considering this particular entity in the diagnosis of genitogluteal plaques, especially those not responding to conventional modalities.

CXCR4 Negatively Regulates Keratinocyte Proliferation in IL-23-Mediated Psoriasiform Dermatitis

CXCR4 is expressed by basal keratinocytes (KCs), but little is known about its function in inflamed skin. We crossed K14-Cre and CXCR4flox/flox (f/f) transgenic mice, resulting in mice with specific loss of the CXCR4 gene in K14-expressing cells (K14-CXCR4KO), including basal KCs. K14-CXCR4KO pups had no obvious skin defects. We compared K14-CXCR4KO and CXCR4f/f control mice in an IL-23-mediated psoriasisform dermatitis model and measured skin edema, histologic, and immunohistological changes. IL-23-treated K14-CXCR4KO mice showed a 1.3-fold increase in mean ear swelling, 2-fold increase in epidermal thickness, and greater parakeratosis. IL-23-treated WT mice showed weak CXCR4 expression in areas of severe epidermal hyperplasia, but strong CXCR4 expression in non-hyperplastic regions, suggesting CXCR4 may regulate keratinocyte proliferation. To test this hypothesis, we overexpressed CXCR4 in HaCaT keratinocyte cells and treated them with IL-22 and/or CXCL12. CXCL12 blocked IL-22-mediated HaCaT cell proliferation in vitro and synergized with IL-22 in upregulating SOCS3, a key regulator of STAT3. SOCS3 was required for CXCR4-mediated growth inhibition. In human psoriatic skin, both CXCR4 and SOCS3 were upregulated in the junctional region at the border of psoriatic plaques. Thus, CXCR4 plays an unexpected role in inhibiting KC proliferation and mitigating the effects of proliferative Th17 cytokines.

Axon‐oligodendrocyte interactions during developmental myelination, demyelination and repair

In multiple sclerosis, CNS demyelination is often followed by spontaneous repair, mostly achieved by adult oligodendrocyte precursor cells. Extent of this myelin repair differs, ranging from very low, limited to the plaque border, to extensive, with remyelination throughout the 'shadow plaques.' In addition to restoring neuronal connectivity, new myelin is neuroprotective. It reduces axonal loss and thus disability progression. Reciprocal communication between neurons and oligodendrocytes is essential for both myelin biogenesis and myelin repair. Hence, deciphering neuron-oligodendrocyte communication is not only important for understanding myelination per se, but also the pathophysiology that underlies demyelinating diseases and the development of innovative therapeutic strategies.

Evaluating the extracranial cerebral arteries with ultrasound angiography

Ultrasound angiography is a new method of colour-coded vessel imaging. The present study aimed at giving further information on its clinical utility in neurosonology. The extracranial arteries of 53 patients and 5 normal persons were investigated by ultrasound angiography in comparison with colour-coded duplex sonography. We found a sharper imaging of stenoses and plaques by ultrasound angiography compared with colour Doppler. The imaging of the vessels can be achieved more continuously, avoiding dropouts of the colour. Small vessels and branches can be detected more reality. Ultrasound angiography represents a valuable additional imaging technique to colour-coded duplex sonography, providing further information, especially with regard to the border of plaques and stenoses.

Perianal squamous cell carcinoma with high-grade anal intraepithelial neoplasia in an HIV-positive patient using highly active antiretroviral therapy: case report

Highly active antiretroviral therapy (HAART) has turned human immunodeficiency virus (HIV) infection into a chronic condition, and this has led to increased incidence of anal dysplasia among HIV-positive patients. Routine anal evaluation including the anal canal and perianal area is recommended for this population, especially for patients infected by oncogenic human papillomavirus (HPV) types. A 54-year-old homosexual HIV-positive man presented with a six-year history of recurrent perianal and anal warts. He had previously undergone incomplete surgical excision and fulguration in another institution on two occasions. He had been using HAART over the past two years. He presented some condylomatous spreading lesions occupying part of the anal canal and the perianal skin, and also a well-demarcated slightly painful perianal plaque of dimensions 1.0 x 1.0 cm. Both anal canal Pap smears and biopsies guided by high-resolution anoscopy revealed high-grade squamous intraepithelial lesion. Biopsies of the border of the perianal plaque also revealed high-grade squamous intraepithelial lesion. HPV DNA testing of the anus detected the presence of HPV-16 type. The patient underwent local full-thickness excision of the lesion. Histological analysis on the excised tissue revealed high-grade squamous intraepithelial lesion with one focus of microinvasive squamous cell cancer measuring 1 mm. No lymph vessel or perineural invasion was detected. The patient showed pathological evidence of recurrent anal and perianal high-grade squamous intraepithelial lesions at the sixth-month follow-up and required further ablation of those lesions. However no invasive squamous cell carcinoma recurrence has been detected so far.

The use of Speckle Reduction Imaging (SRI) Ultrasound in the characterization of carotid artery plaques

Background and purpose Speckle Reduction Imaging is a new algorithm that improves the image quality of B-mode scanning by reducing the reverberation artifacts. In the present study the value of this method for the characterization of atherosclerotic plaques in the internal carotid artery was investigated. Methods Two hundred and twenty two patients (161 men, 61 women; mean age 73 years) referred for carotid ultrasound evaluation were included in the study. Patients with plaques of the internal carotid artery as identified by conventional B-mode scanning were investigated also with the addition of Speckle Reduction Imaging (SRI) with the use of a 4–11-MHz wide band linear transducer. Plaque morphology was rated according to a standardized protocol by two independent observers. Results For the determination of plaque echogenicity, the reproducibility of SRI ( κ = 0.83) was higher than that of conventional B-mode ultrasound ( κ = 0.68). The interobserver agreement for plaque surface characterization was also higher for SRI ( κ = 0.8) than for conventional B-mode ( κ = 0.61). At the evaluation of the image quality through a semiquantitative analysis, SRI was rated superior in the plaque texture resolution, plaque borders determination, vessel wall demarcation and fibrous cap depiction. In addition, the level of “speckle” was reduced with the use of SRI. Conclusions SRI is a technique that shows good general agreement with high-resolution B-mode and can be used for the characterization of atherosclerotic plaques in the carotid artery. Furthermore, because this advanced technique allows reduction of ultrasound artifacts, it improves the image quality allowing more precise visualization of plaque morphological details.

Topographic association of angioscopic yellow plaques with coronary atherosclerotic plaque: assessment with quantitative colorimetry in human coronary artery autopsy specimens

Yellow plaques seen during coronary angioscopy are thought to be the surrogates for superficial intimal lipids in coronary plaque. Given diffuse and heterogeneous nature of atherosclerosis, yellow plaques in coronaries may be seen as several yellow spots on diffuse coronary plaque. We examined the topographic association of yellow plaques with coronary plaque. In 40 non-severely stenotic ex-vivo coronary segments (average length: 52.2 +/- 3.1 mm), yellow plaques were examined by angioscopy with quantitative colorimetry. The segments were cut perpendicular to the long axis of the vessel at 2 mm intervals, and 1045 slides with 5 microm thick tissue for whole segments were prepared. To construct the plaque surface, each tissue slice was considered to be representative of the adjacent 2 mm. The circumference of the lumen and the lumen border of plaque were measured in each slide, and the plaque surface region was constructed. Coronary plaque was in 37 (93%) of 40 segments, and consisted of a single mass [39.9 +/- 3.9 (0-100) mm, 311.3 +/- 47.4 (0.0-1336.2) mm2]. In 30 (75%) segments, multiple (2-9) yellow plaques were detected on a mass of coronary plaque. The number of yellow plaques correlated positively with coronary plaque surface area (r = 0.77, P < 0.0001). Yellow plaques in coronaries detected by angioscopy with quantitative colorimetry, some of them are associated with lipid cores underneath thin fibrous caps, may be used to assess the extent of coronary plaque. Further research using angioscopy could be of value to study the association of high-risk coronaries with acute coronary syndromes.