No abstract

BACKGROUND AND PURPOSE: Various ultrasonographic features of carortid plaques have been associated with the occurence of stroke, highlighting the need for multi-parametric assessment of plaque's vulnerability. Our aim was to compare ultrasonographic multiparametric indices using color Doppler imaging and contrast-enhanced sonography between symptomatic and asymptomatic carotid plaques. MATERIALS AND METHODS: This was a cross-sectional observational study recruiting 54 patients (72.2% male; median age, 61 years) undergoing sonography and contrast-enhanced sonography. Patients were included if a moderately or severely stenotic internal carotid artery plaque was detected, with the plaque being considered symptomatic if it was ipsilateral to a stroke occuring within the last 6 months. A vulnerability index, previously described by Kanber et al, combined the degree of stenosis, gray-scale median, and a quantitative measure of surface irregularities (surface irregularity index) derived from color Doppler imaging and contrast-enhanced ultrasonography, resulting in 2 vulnerability indices, depending on the surface irregularity index used. Mann-Whitney U and t tests were used to compare variables between groups, and receiver operating characteristic curves were used to compare diagnostic accuracy. RESULTS: Sixty-two plaques were analyzed (50% symptomatic), with a mean degree of stenosis of 68.9%. Symptomatic plaques had a significantly higher degree of stenosis (mean, 74.7% versus 63.1%; P Ͻ .001), a lower gray-scale median (13 versus 38; P ϭ .001), and a higher Kanber vulnerability index based both on color Doppler imaging (median, 61.4 versus 16.5; P Ͻ .001) and contrast-enhanced ultrasonography (median, 88.6 versus 25.2; P Ͻ .001). The area under the curve for the detection of symptomatic plaques was 0.772 for the degree of stenosis alone, 0.783 for the vulnerability index-color Doppler imaging, and 0.802 for the vulnerability index-contrast-enhanced ultrasonography, though no statistical significance was achieved. CONCLUSIONS: Symptomatic plaques had a higher degree of stenosis, lower gray-scale median values, and higher values of the Kanber vulnerability index using both color Doppler imaging and contrast-enhanced ultrasonography for plaque surface delineation. ABBREVIATIONS: AUC ϭ area under the curve; CEUS ϭ contrast-enhanced ultrasonography; CDI ϭ color Doppler imaging; DOS ϭ degree of stenosis; GSM ϭ gray-scale median; IQR ϭ interquartile range; ROC ϭ receiver operating characteristic; SII ϭ surface irregularity index; US ϭ ultrasonography; VI ϭ vulnerability index C arotid atherosclerosis accounts for approximately 10%-15% of all strokes, with thromboembolism from a moderate or severe stenosis representing the underlying mechanism. The degree of internal carotid artery stenosis has long been used as the primary parameter considered for guiding treatment of patients with carotid disease. Nevertheless, it is now well-established that additional plaque features contribute to the vulnerability of the plaque, a term ...

HP was considered an extremely rare manifestation of GPA. However, recent studies are reporting an increased frequency of HP and are distinguishing a granulomatous and a vasculitic phenotype, with different localization and relapse rates, that may eventually constitute a different clinical spectrum of GPA.