Plaque Echogenicity Research Articles

Increased Echolucency of Carotid Plaques in Patients With Type 2 Diabetes

Diabetes is associated with the presence of moderate to large atherosclerotic carotid plaques. Previous carotid ultrasound studies have associated plaques with low echogenicity with a higher risk of cerebrovascular events. The aim of this study was to evaluate whether patients with type 2 diabetes have different plaque echogenicity than do nondiabetic subjects. Forty-seven type 2 diabetic and 51 nondiabetic subjects with a carotid plaque in the right artery were included in this study. All patients were born in 1935 to 1936 and were participants in a population-based study. Carotid ultrasonography was performed and the risk factors for cardiovascular disease were determined. Plaque echogenicity was assessed quantitatively on B-mode ultrasound images by standardized gray-scale median values. Gray-scale median values were significantly lower, indicating more echolucent plaques, in patients with type 2 diabetes compared with nondiabetics (37.0+/-14.8 vs 45.5+/-15.4, P=0.007). Of the other risk factors studied, only triglycerides were significantly associated with the echogenicity of the plaque. Patients with type 2 diabetes have more echolucent plaques compared with nondiabetic subjects. This might be associated with the higher risk of cardiovascular events among diabetics.

Compositional analysis of angioscopic yellow plaques with intravascular ultrasound radiofrequency data

Background To identify subclinical high-risk plaques is potentially important because those vulnerable plaques may have a greater likelihood of rupture and subsequent thrombosis. The aim of this study is to reveal the histology of angioscopic yellow plaques known as vulnerable plaques by intravascular ultrasound radiofrequency data analysis. Methods Thirty-one coronary plaques in 21 patients, which were non-culprit, de novo, angiographically non-obstructive (< 50%) lesions, were analyzed with Virtual Histology™- intravascular ultrasound (VH-IVUS) and coronary angioscopy. These plaques were prospectively divided into 4 groups (Grade0 to 3) by the yellow color intensity and we compared plaque morphology, echogenicity and composition among their groups. Results Morphology and echogenicity evaluated by standard gray-scale IVUS were not significantly different among those groups. On analyzing plaque composition by VH-IVUS, mean percentage of necrotic core was significantly larger in yellow plaque (Grade 2 and 3) than white plaque (Grade 0). Conclusions Angioscopic yellow plaque included a larger amount of necrotic core analyzed by VH-IVUS than white plaque.

Metallothionein expression in the high-risk carotid atherosclerotic plaque

ABSTRACTObjective: Metallothioneins (MTs) are antioxidant proteins expressed in response to injury. We evaluated MT immuno­reactivity in carotid plaques obtained from asymptomatic and symptomatic patients. We also assessed the relationship between ultrasonic plaque echodensity, histological grading, computed tomography findings and MT expression.Methods and results: In this ongoing prospective study, patients (n = 123, mean age (± SD) 68.4 ± 7.7 years, 97 men) with high-grade carotid stenosis underwent carotid endarterectomy. Specimens were assessed histologically and immunohistochemically. Echolucent plaques (types 1+2) were more common in symptomatic patients ( p < 0.0001) and had more advanced histological lesions ( p < 0.0001). Echolucent plaques expressed MTs (in macrophages, fibroblasts and T-lymphocytes) significantly more than echogenic plaques (types 3+4) (all p < 0.0001). MT expression was mainly related to carotid plaque echolucency rather than the presence of symptoms. MT expression was significantly more common in advanced histological lesions. Plaques from asymptomatic or symptomatic patients with abnormal computed tomography findings also showed increased MT expression. There was a time-dependent fall in MT expression after cerebrovascular events ( p ≤ 0.011).Conclusions: MT overexpression may be triggered in unstable plaques as a local protective factor. There is a need to identify both causative and protective predictors of the ‘vulnerable plaque’ in the ‘vulnerable patient’. Further studies are needed to resolve these issues.

The impact of carotid artery plaque echogenicity on the rate of solid cerebral microembolism during carotid artery stenting

The impact of carotid artery plaque echogenicity on the rate of solid cerebral microembolism during carotid artery stenting

Carotid Plaque Echogenicity and Risk of Nonvertebral Fractures in Women: A Longitudinal Population-Based Study

Atherosclerosis and osteoporosis appear to be related, but prospective studies on the relationship are sparse. In order to examine whether carotid artery plaques with different morphology predict nonvertebral fractures, we followed 2,733 women, aged 55-74 years (75% of the eligible population in Tromsø, Norway), for 6 years. At baseline, plaque morphology in terms of ultrasound echogenicity was categorized into three groups, ranging from low echogenicity (echolucent plaques with a high content of soft tissue) to strong echogenicity (echogenic plaques with a high content of dense fibrous tissue and calcified material). We found that the age-adjusted relative risk (RR) of fracture was significantly higher among women with echogenic plaques than among women without plaques: 1.7 (95% confidence interval [CI] 1.0-2.7). After adjustment for bone mineral density at baseline in addition to age, the RR was 1.6 (95% CI 1.0-2.6), and further adjustments for body mass index, body height, high-density lipoprotein cholesterol, smoking status, and muscle strength did not influence the association. Subjects with other plaque types were not at an increased risk compared to subjects without plaques: RR < or = 1.1, after multiple adjustments. We conclude that in the general population elderly women with echogenic carotid plaques are at higher risk of nonvertebral fractures than women without plaques.

Risk for transient ischemic attacks is mainly determined by intima-media thickness and carotid plaque echogenicity

Background Stenosis severity, plaque morphology, and intima-media thickness (IMT), all have been found to provide prognostic information in patients with asymptomatic carotid artery disease. However, limited data exist on the association between these parameters and the risk for transient ischemic attack (TIA). Methods We compared the ultrasonographic characteristics of 88 consecutive patients with first TIA without known cardioembolic source with those of 176 propensity-matched asymptomatic control subjects. Results IMT was higher in TIA patients compared to control subjects (0.74 ± 0.14 mm versus 0.68 ± 0.13 mm, p = 0.001). Plaques were found in 70.5% of patients and 64.8% of controls ( p = 0.407). Compared with controls, TIA patients demonstrated more frequently predominantly echolucent lesions (77.4% versus 56.1%, p = 0.005) and high-grade carotid stenoses (21.0% versus 9.6%, p = 0.042). TIA patients with low-to-moderate grade (<70%) lesions exhibited higher IMT and more prevalent echolucent morphology in comparison with their control counterparts. No significant differences were observed between groups regarding high-grade lesions. In multivariate models, IMT and plaque echogenicity, but not stenosis severity, emerged as independent determinants of risk. Conclusions Risk for TIA is primarily associated with IMT and plaque echogenicity, especially in the absence of high-grade lesions. Stenosis severity appears to be of limited prognostic value.

Serum osteoprotegerin is inversely associated with carotid plaque echogenicity in humans

Osteoprotegerin (OPG) is a member of the tumour necrosis factor superfamily involved in the regulation of bone metabolism and vascular calcification. High serum values of OPG are associated with cardiovascular disease in humans. The purpose was to investigate serum OPG levels in subclinical carotid atherosclerosis and the relation between OPG levels and plaque morphology. OPG levels were compared in 29 persons with echogenic carotid plaques, 30 persons with echolucent plaques and 41 persons without carotid plaques, all recruited from a population health study. Computerized assessment of plaque echogenicity was done by use of the gray scale median (GSM). Participants with echogenic carotid plaques had lower serum OPG level (1.23 ng/ml; 1.02–1.48) (geometric mean; 95% CI) than persons with echolucent plaques (1.76 ng/ml; 1.46–2.14) and those without plaques (1.89 ng/ml; 1.60–2.21). OPG and PTH were independently related to GSM. A significant trend for decrease in GSM across quartiles of OPG was found ( p = 0.003) which remained significant even after adjustment for PTH and smoking. The present study demonstrates lower serum OPG levels in persons with subclinical echogenic carotid plaques and identified an inverse relation between serum OPG and plaque echogenicity. The findings support the concept that OPG may play an important role in arterial calcification.

Noninvasive Tissue Characterization of Coronary Arterial Plaque by 16-Slice Computed Tomography in Acute Coronary Syndrome

Noninvasive characterization of coronary plaques is challenging for cardiologists. The authors' goal was to explore the clinical feasibility of newly developed 16-slice computed tomography (CT) in tissue characterization of coronary arterial plaques in patients with acute coronary syndrome. Sixteen patients with acute coronary syndrome underwent 16-slice CT (Aquillion, Toshiba) and coronary arteriography with intravascular ultrasound (IVUS) within 7 days. Twenty-three plaques were classified by IVUS according to plaque echogenicity: 6 soft plaques, 11 intermediate plaques, and 6 calcified plaques. Mean (+/- SD) CT numbers (Hounsfield units [HU]) of these 3 types of plaques were 50.6 +/-14.8 HU, 131 +/-21.0 HU, and 721 +/-231 HU, respectively. Sixteen-slice CT facilitates noninvasive tissue characterization of coronary arterial plaques.

The Impact of Carotid Artery Plaque Echogenicity on the Rate of Solid Cerebral Microembolism during Carotid Artery Stenting

The Impact of Carotid Artery Plaque Echogenicity on the Rate of Solid Cerebral Microembolism during Carotid Artery Stenting

Noninvasive Detection of Subclinical Coronary Atherosclerosis Coupled With Assessment of Changes in Plaque Characteristics Using Novel Invasive Imaging Modalities: The Integrated Biomarker and Imaging Study (IBIS)

Our purpose was to assess noninvasive imaging in detection of subclinical atherosclerosis and to examine novel invasive modalities to describe prevalence and temporal changes in putative characteristics of "high-risk" plaques.Conventional coronary imaging cannot identify "high-risk" lesions.Conventional (quantitative angiography and intravascular ultrasound [IVUS]) and novel imaging (IVUS-based palpography and gray scale echogenicity) were performed at baseline and 6 months later in 67 patients with diverse clinical presentations. Different imaging techniques were compared within a common segment defined by multislice computed tomography (MSCT).Compared with IVUS, the sensitivity, specificity, and positive and negative predictive value of MSCT for detecting significant plaque was 86%, 69%, 90%, and 61%, respectively. In coronary arteries with <50% stenosis, there were no temporal changes in luminal and plaque dimensions measured by quantitative coronary angiography or IVUS; however, a significant reduction in abnormal strain pattern was detected on palpography (density high strain spots/cm: 1.6 +/- 1.5 vs. 1.2 +/- 1.4, p = 0.0123. These changes were mainly related to significant changes in patients who presented with ST-segment elevation myocardial infarction. The assessment of plaque echogenicity showed no temporal changes. There were no correlations between circulating biomarkers and quantifiable imaging parameters.Mild angiographic disease is associated with large atherosclerotic plaques on MSCT. Conventional invasive coronary imaging reveals static luminal and plaque dimensions on standard medical therapy with plaque hypoechogenicity remaining unchanged over the 6-month period. By contrast, palpography measurements of strain correlate with clinical presentation and significantly decrease on standard medical therapy. Novel imaging modalities, such as palpography, might provide insights into plaque biology and might eventually serve as intermediate end points in interventional trials.

Circulating oxidized low-density lipoprotein is associated with echolucent plaques in the femoral artery independently of hsCRP in 61-year-old men

Objectives The aim of the study was to test the hypothesis that circulating markers of inflammation (high-sensitive C-reactive protein, hsCRP) and oxidative modification of lipids (oxidized low-density lipoprotein, oxLDL) were associated with the occurrence of echolucent rather than echogenic femoral artery plaques in a cross-sectional population based cohort of 513, 61-year-old men. Background The relationships between circulating oxLDL, hsCRP and the occurrence of echolucent plaques in the femoral artery have not previously been investigated. Methods The levels of circulating oxLDL and hsCRP were determined in plasma by ELISA. Plaque occurrence, size and echogenicity were measured by B-mode ultrasound in the right femoral artery. Assessment of plaque echogenicity was based on the classification (grades 1–4) proposed by Gray-Weale et al. Results A higher frequency of echolucent femoral plaques was observed in subjects with the metabolic syndrome and current smokers ( p = 0.01 and p < 0.001, respectively) as well as with increasing levels of oxLDL and hsCRP ( p = 0.002 and p = 0.005, respectively). In a multiple logistic regression analysis oxLDL and current smokers turned out to be independent associated with the presence of echolucent femoral artery plaques. Conclusions The results of the present study support our hypothesis that circulating oxLDL is a marker of an unstable echolucent plaque phenotype in the femoral artery in man.

Hyperechoic Plaque: An Ultrasound Marker for Osteoporosis in Acute Stroke Patients with Carotid Disease

Background: Osteoporosis is a significant complication of stroke, and hip fracture after a stroke is a frequent problem. Moreover, growing evidence links vascular and bone diseases, in the form of osteoporosis associated with both atherosclerosis and vascular calcification. The aim of our study is to detect bone change in the acute phase of ischemic stroke in patients with carotid disease and to verify the correlation with carotid echogenic plaques. Patients and Method: Out of 245 subjects consecutively admitted to our Stroke Unit for their first ischemic stroke, we selected 49 patients with a first-ever stroke due to carotid atherosclerosis without a previous diagnosis of bone disease. We assessed risk factors for cerebrovascular disease as well as for osteoporosis, the degree of neurological deficit and disability, and bone mineral density that was quantified by bilateral hip dual energy X-ray absorbimetry. Osteoporosis was defined as a T score below –2.5. Carotid ultrasound was used to classify plaques in non-hyperechoic (grade 1) and hyperechoic plaque (grade 2). Results: We found a high prevalence of low bone mass density (BMD) in our patients (18 out of 49 = 36.7%), without relationship to the side of paresis. According to univariate analysis evidence of osteoporosis was correlated with age (p = 0.05), score of Scandinavian Stroke Scale (p = 0.01) and grade 2 plaque (p = 0.01). According to multivariate analysis, there was a significant positive correlation between grade 2 plaques and osteoporosis (OR = 6.58; 95% CI = 1.57–27.54; p = 0.01), which was stronger in women (OR = 18.15; 95% CI = 1.80–182.83; p = 0.01). The percentage of intraplaque hyperechogenicity was inversely correlated with BMD (r = –0.411, p = 0.016). Conclusion: Osteoporosis is highly prevalent in acute atherosclerotic stroke patients. Carotid hyperechoic plaque is an independent marker of osteoporosis.

Endothelial dysfunction and systemic inflammation in persons with echolucent carotid plaques

Echolucent carotid plaques are associated with high risk for future ischemic cerebrovascular events independent of the degree of stenosis. Elevated levels of markers of systemic inflammation and endothelial dysfunction are predictors for future myocardial infarction and stroke. The present study was undertaken to investigate the relations between plaque morphology, endothelial dysfunction assessed by tissue-plasminogen activator antigen (t-PA ag) and vonWillebrand factor (vWF), and systemic inflammation in persons with carotid stenosis. We conducted a crosssectional study including 133 persons with carotid stenosis and 138 controls without stenosis recruited from the populationbased Tromsø Study. High-resolution B-mode and colour Doppler/pulsed-wave Doppler ultrasonography of both carotid arteries was performed, and plaque morphology in terms of echogenicity was assessed. Persons with carotid stenosis had significantly higher plasma t-PA and vWF concentrations than controls. There was a significant inverse relationship between t-PA ag and plaque echogenicity (p = 0.034). The increased plasma t-PA ag in persons with carotid stenosis was not associated with increased plasminogen activator inhibitor-I (PAI-1). Persons with echolucent carotid plaques had higher degree of systemic inflammation, and plasma t-PA and vWF concentration increased significantly across quartiles of WBC, fibrinogen, and hs-CRP. Our findings may suggest that plasma t-PA may be superior to vWF as a marker for endothelial dysfunction due to its ability to discriminate between various plaque echogenicity, and that the predictive role of t-PA ag in cardiovascular disease is independent of inhibited fibrinolysis.

Elastin and Calcium Rather than Collagen or Lipid Content Are Associated With Echogenicity of Human Carotid Plaques

Elastin and Calcium Rather than Collagen or Lipid Content Are Associated With Echogenicity of Human Carotid Plaques

Mo-P4:285 Risk for transient ischemic attacks is mainly determined by intima-media thickness and carotid plaque thickness and carotid plaque echogenicity

Mo-P4:285 Risk for transient ischemic attacks is mainly determined by intima-media thickness and carotid plaque thickness and carotid plaque echogenicity

The impact of carotid artery plaque echogenicity on the rate of solid cerebral microembolism during carotid artery stenting

The impact of carotid artery plaque echogenicity on the rate of solid cerebral microembolism during carotid artery stenting

Mo-ML1:1 Dyslipidemia in renal impairment — from pathophysiology to evidence

Our purpose was to assess noninvasive imaging in detection of subclinical atherosclerosis and to examine novel invasive modalities to describe prevalence and temporal changes in putative characteristics of “high-risk” plaques.Conventional coronary imaging cannot identify “high-risk” lesions.Conventional (quantitative angiography and intravascular ultrasound [IVUS]) and novel imaging (IVUS-based palpography and gray scale echogenicity) were performed at baseline and 6 months later in 67 patients with diverse clinical presentations. Different imaging techniques were compared within a common segment defined by multislice computed tomography (MSCT).Compared with IVUS, the sensitivity, specificity, and positive and negative predictive value of MSCT for detecting significant plaque was 86%, 69%, 90%, and 61%, respectively. In coronary arteries with <50% stenosis, there were no temporal changes in luminal and plaque dimensions measured by quantitative coronary angiography or IVUS; however, a significant reduction in abnormal strain pattern was detected on palpography (density high strain spots/cm: 1.6 ± 1.5 vs. 1.2 ± 1.4, p = 0.0123. These changes were mainly related to significant changes in patients who presented with ST-segment elevation myocardial infarction. The assessment of plaque echogenicity showed no temporal changes. There were no correlations between circulating biomarkers and quantifiable imaging parameters.Mild angiographic disease is associated with large atherosclerotic plaques on MSCT. Conventional invasive coronary imaging reveals static luminal and plaque dimensions on standard medical therapy with plaque hypoechogenicity remaining unchanged over the 6-month period. By contrast, palpography measurements of strain correlate with clinical presentation and significantly decrease on standard medical therapy. Novel imaging modalities, such as palpography, might provide insights into plaque biology and might eventually serve as intermediate end points in interventional trials.

Penetrating Atheroma in Cervical Carotid Artery Stenosis-Case Report-

A 61-year-old male presented with left hand motor weakness associated with cerebral infarction in the right frontal lobe. Right common carotid angiography demonstrated a 66% stenosis and carotid duplex scan demonstrated intermediate echogenic plaque, indicating typical carotid plaque. Carotid endarterectomy was performed 22 weeks after the ischemic onset. During exposure of the carotid artery, a soft and yellowish mass (5 x 5 mm) was observed in the lateral wall of the carotid bulbus, which was not covered with adventitia but with thin connective tissue. The mass was removed en-bloc with a small part of the surrounding arterial wall combined with ordinary endarterectomy. The artery was closed with a collagen-impregnated polyester patch graft (Hemashield patch) to maintain adequate arterial lumen. Histological examination of the removed plaque confirmed that atheroma had protruded from the intima through the media as well as the adventitia and formed an extra-arterial mass. Such a case requires great care to dissect the carotid artery to prevent premature disintegration of the atheroma.

Repeated visual and computer-assisted carotid plaque characterization in a longitudinal population-based ultrasound study: The Tromsø study

In a longitudinal population-based ultrasound survey, we evaluated the reproducibility of carotid plaque detection, off-line vs. online visual classification of plaque echogenicity and computer-assisted plaque echogenicity (grey-scale median, GSM) classification and plaque area measurements. The number of paired observations in the reproducibility analyses was 107 in the baseline study and 83 in the follow-up study. In addition, 198 and 222 images were selected from the baseline and the follow-up study for GSM- and plaque-area analyses. The total number of plaque images (11,160) was used to obtain comparative reference values. Despite good agreement in the reproducibility study (κ values ranging from 0.52 to 0.57), there was a substantial drift in online visual classification of plaque echogenicity during the survey period. Inter- and intraobserver agreement on computer-assisted GSM classification was substantial, with κ values (95% CI) of 0.77 (0.73 to 0.80) and 0.79 (0.75 to 0.84), respectively. A systematic bias in plaque area measurements was observed. Visual online classification may introduce systematic measurement errors that are not intercepted in a reproducibility study of restricted duration. Computer-assisted off-line classification had better reproducibility. However, the method is influenced by measurement errors, both in the outlining of the plaque and in the standardization procedure. (E-mail: einar.fosse@ism.uit.no)

Characterization of symptomatic and asymptomatic carotid plaques using high-resolution real-time ultrasonography.

High-resolution ultrasonography was used to classify carotid plaques into five different types in 72 patients with symptoms and in 49 without, and with stenosis of the origin of the internal carotid artery > 70 per cent. There were 72 plaques in the symptomatic group and 75 in the asymptomatic group. Type 1 plaques were uniformly echolucent, type 2 predominantly echolucent, type 3 predominantly echogenic, type 4 uniformly echogenic and type 5 consisted of plaques that could not be classified owing to heavy calcification and acoustic shadows. Type 1 plaque was found in 90 per cent of patients with symptoms and in 10 per cent of those without, type 2 plaque was found in 53 and 47 per cent, type 3 in 34 and 66 per cent, and type 4 in 5 and 95 per cent, respectively. The preponderance of echolucent plaques in symptomatic patients with stenosis > 70 per cent supports the hypothesis that this type of plaque is unstable and tends to embolize. In contrast, in patients without symptoms there is preponderance of echogenic plaques.