ABSTRACT Aim: The traditional morphological parameters for the description of a carotid atherosclerotic plaque (degree of stenosis, echogenicity, systolic peak velocity etc.) are insufficient for the prediction of the risk of embolization. Contrast Enhanced Ultrasound (CEUS), based on the theory of inflammation and neoangiogenesis, seems to have a great potential for the detection of unstable plaques. The purpose of our work is to compare echogenicity of the plaque (evaluated with the Grey Scale Median; GSM), the degree of stenosis and CEUS with the histopathological findings. Methods: Patients with indication for internal carotid endarterectomy (CEA) underwent to a pre-operative imaging study with B-mode echo Doppler Ultrasound and with CEUS. The contrast enhancement of the plaque was described with two parameters: the maximum and mean signal intensity (SImax, SImean). After the surgical operation the removed plaque is sent to the pathology laboratory for the measurement of the neoangiogenesis (Vessel Density; VD). Results: Fifty one consecutive patients were enrolled (12 symptomatic, 39 asymptomatic). Analysis pointed out significant differences between symptomatic and asymptomatic patients for: GSM 22·25±16·58 versus 34·38±14·71 (P=0·012); SI (%) SImax 32·33±5·38 versus 23·26±5·91 (P<0·001 ) and SImean 22·42±6·93 versus 13·33±6·76 (P<0·001); VD (vessels/mm2 ) 53·46±33·43 versus 12·58±7·12 (P<0·001) respectively. Moreover a cut-off value was determined between the two groups for each parameter: GSM:25, SImax:28%, SImean:20%, and VD:25/mm2. Combined analysis showed that plaques with greater contrast enhancement had more newly formed capillaries and that plaques with lower GSM values correlated with greater vascularization. Conclusion: The study confirms that in vitro neoangiogenesis, contrast enhancement and stability of the plaque are strongly connected and CEUS appears to be one of the most promising tools for the stratification of the carotid plaque vulnerability.

Contrast carotid ultrasound for the detection of plaque at higher risk of embolism.

RISPOLI, Pietro;VARETTO, Gianfranco;GARNERI, PAOLO;CASTAGNO, Claudio;L. Gibello
2013-01-01

Abstract

ABSTRACT Aim: The traditional morphological parameters for the description of a carotid atherosclerotic plaque (degree of stenosis, echogenicity, systolic peak velocity etc.) are insufficient for the prediction of the risk of embolization. Contrast Enhanced Ultrasound (CEUS), based on the theory of inflammation and neoangiogenesis, seems to have a great potential for the detection of unstable plaques. The purpose of our work is to compare echogenicity of the plaque (evaluated with the Grey Scale Median; GSM), the degree of stenosis and CEUS with the histopathological findings. Methods: Patients with indication for internal carotid endarterectomy (CEA) underwent to a pre-operative imaging study with B-mode echo Doppler Ultrasound and with CEUS. The contrast enhancement of the plaque was described with two parameters: the maximum and mean signal intensity (SImax, SImean). After the surgical operation the removed plaque is sent to the pathology laboratory for the measurement of the neoangiogenesis (Vessel Density; VD). Results: Fifty one consecutive patients were enrolled (12 symptomatic, 39 asymptomatic). Analysis pointed out significant differences between symptomatic and asymptomatic patients for: GSM 22·25±16·58 versus 34·38±14·71 (P=0·012); SI (%) SImax 32·33±5·38 versus 23·26±5·91 (P<0·001 ) and SImean 22·42±6·93 versus 13·33±6·76 (P<0·001); VD (vessels/mm2 ) 53·46±33·43 versus 12·58±7·12 (P<0·001) respectively. Moreover a cut-off value was determined between the two groups for each parameter: GSM:25, SImax:28%, SImean:20%, and VD:25/mm2. Combined analysis showed that plaques with greater contrast enhancement had more newly formed capillaries and that plaques with lower GSM values correlated with greater vascularization. Conclusion: The study confirms that in vitro neoangiogenesis, contrast enhancement and stability of the plaque are strongly connected and CEUS appears to be one of the most promising tools for the stratification of the carotid plaque vulnerability.
2013
32
Suppl. to No. 5
3
4
P. Rispoli; G. Varetto; P. Garneri; A. Gattuso; C. Castagno; L. Gibello
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/140225
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