BACKGROUND AND PURPOSE:Ulceration is a severe complication of carotid plaque. The purpose of this study was to evaluate the role and the diagnostic efficacy of multidetector row CT angiography (MDCTA) and ultrasound (US) echo color Doppler (US-ECD) in the study of patients with carotid plaque complicated by ulceration through the comparison with the surgical observation.

The aim of this paper is to describe a novel and completely automated technique for carotid artery (CA) recognition, far (distal) wall segmentation, and intima-media thickness (IMT) measurement, which is a strong clinical tool for risk assessment for cardiovascular diseases. The architecture of completely automated multiresolution edge snapper (CAMES) consists of the following two stages: 1) automated CA recognition based on a combination of scale-space and statistical classification in a multiresolution framework and 2) automated segmentation of lumen-intima (LI) and media-adventitia (MA) interfaces for the far (distal) wall and IMT measurement. Our database of 365 B-mode longitudinal carotid images is taken from four different institutions covering different ethnic backgrounds. The ground-truth (GT) database was the average manual segmentation from three clinical experts. The mean distance ± standard deviation of CAMES with respect to GT profiles for LI and MA interfaces were 0.081 ± 0.099 and 0.082 ± 0.197 mm, respectively. The IMT measurement error between CAMES and GT was 0.078 ± 0.112 mm. CAMES was benchmarked against a previously developed automated technique based on an integrated approach using feature-based extraction and classifier (CALEX). Although CAMES underestimated the IMT value, it had shown a strong improvement in segmentation errors against CALEX for LI and MA interfaces by 8% and 42%, respectively. The overall IMT measurement bias for CAMES improved by 36% against CALEX. Finally, this paper demonstrated that the figure-of-merit of CAMES was 95.8% compared with 87.4% for CALEX. The combination of multiresolution CA recognition and far-wall segmentation led to an automated, low-complexity, real-time, and accurate technique for carotid IMT measurement. Validation on a multiethnic/multi-institutional data set demonstrated the robustness of the technique, which can constitute a clinically valid IMT measurement for assistance in atherosclerosis disease management.

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The results of our retrospective study suggest that there is no correlation between total carotid atherosclerotic plaque volume and ulcerations, whereas plaque relative lipid volume (using attenuation of < 60 HU) is associated with the presence of ulceration. This finding could indicate vulnerable plaques and increased risk for cerebrovascular events.