Computer-Assisted Ultrasonographic Analysis of Carotid Plaques in Relation to Cerebrovascular Symptoms, Cerebral Infarction, and Histology

Matsagas, Miltiadis I.; Vasdekis, Spyros N.; Gugulakis, A.; Lazaris, Andreas; Foteinou, Marianthi; Sechas, M

doi:10.1007/s100169910024

Cited by 36 publications

(26 citation statements)

References 26 publications

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“…We excluded 17 that were validation studies comparing plaque imaging with histology [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] ; 7 that failed to provide sufficient data for each group 25,26,50 -54 ; 4 that were highly selected studies 19,[55][56][57] ; 2 that included patients with extracranial restenosis 58,59 ; and 8 that were duplicate records. 1,3,5,14,21,60 -62 The group sizes were very different in 1 study.…”

Section: Resultsmentioning

confidence: 99%

Correlation Between Carotid Intraplaque Hemorrhage and Clinical Symptoms

Gao

Chen

Bao

et al. 2007

Stroke

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Background and Purpose-We sought to investigate the association between carotid intraplaque hemorrhage (IPH) and ipsilateral symptoms of cerebral ischemia. Methods-A search was performed for clinical observational studies comparing the incidence of IPH between symptomatic and asymptomatic patients. Odds ratios (ORs) for IPH as a factor in the pathogenesis of neurologic events were calculated and combined by a meta-analysis. Interstudy heterogeneity, estimated effects, and methodologic quality of the studies were assessed. Results-Thirty-one studies were included for analysis. The reported ORs varied widely. Overall, the incidence of IPH in the symptomatic groups was significantly higher than in the asymptomatic group. However, there was an apparent trend for heterogeneity (PϽ0.00001) between studies. The random-effects summary estimator of ORs was 2.25 (95% CI, 1.57 to 3.22; PϽ0.00001). To identify potential sources of heterogeneity, subgroup analyses were performed. The pooled ORs varied greatly by stratification. Major heterogeneity was found among studies with low quality, microscopic methods of examination, significant effects, small sizes, early publication, and unequal severity of carotid stenosis in both groups. Large, recent, macroscopic, or high-quality studies, as well as studies with equal degrees of stenosis, tended to yield insignificant associations. The methods in defining and evaluating hemorrhage were very heterogeneous. Characterizations of the age, size, number, and location of hemorrhages were poorly reported and highly variable. In addition, a lack of control of confounders and selection bias were frequently identified among studies. Conclusions-Statistical inferences have suggested a plausible role in the production of cerebral ischemia; however, reliable interpretation was strongly undermined by poor methodologic quality, substantial heterogeneity, and suspicious publication bias. To preciously estimate the underlying correlation, a well-designed study with uniformity in definition and evaluation for IPH might be warranted.

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Section: Resultsmentioning

confidence: 99%

Correlation Between Carotid Intraplaque Hemorrhage and Clinical Symptoms

Gao

Chen

Bao

et al. 2007

Stroke

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“…4,5,10,31 These various cut-off points may be attributable to different choices for the standardization of the reference values. 5,12 For the purpose of the present study, we decided to choose the threshold value of 50 by using the usual recommended reference values for the blood and the adventitia. However, we believe that other cut-off points should also be further investigated to determine the most sensitive threshold value.…”

Section: Discussionmentioning

confidence: 99%

Stratified Gray-Scale Median Analysis and Color Mapping of the Carotid Plaque

Sztajzel

Momjian

Momjian-Mayor

et al. 2005

Stroke

111

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Background and Purpose-To determine whether a stratified gray-scale median (GSM) analysis of the carotid plaque combined with color mapping could predict plaque histology better than an overall GSM measurement. Methods-Thirty-one carotid plaques derived from 28 patients undergoing carotid endarterectomy were investigated by ultrasound. GSMs of the whole plaque were used as measurement of echogenicity. A profile of the regional GSM as a function of distance from the plaque surface could be generated. Plaque pixels were further mapped into 3 different colors depending on their GSM value. Results-Plaques with large calcifications presented the highest GSM values, and those with large hemorrhagic areas or with a predominant necrotic core exhibited the lowest. Fibrous plaques had intermediate GSM values. A necrotic core located in a juxtalumenal position was associated with significantly lower GSM values (Pϭ0.009) and with a predominant red color (GSM Ͻ50) at the surface (Pϭ0.0019). With respect to the thickness of the fibrous cap and the position of the necrotic core, the sensitivity and specificity of the predominant red color of the whole plaque was respectively 45% and 67% and 53% and 75%; considering the predominant red color of the surface, the sensitivity and specificity increased to 73% and 67% and 84% and 75%, respectively. Conclusions-The stratified GSM measurement combined with color mapping showed a good correlation with the different histopathological components and further allowed identification with good accuracy of determinants of plaque instability. This approach should be investigated in a prospective, natural history study.

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“…Thus far, various cut-offs have been used. 9,36,37 We used the 25th percentile of GSM score because this value was low enough to identify hypoechoic plaques in a number of patients sufficiently high for statistical analysis purposes. Importantly, the cut-off value we found (i.e.…”

Section: Study Limitationsmentioning

confidence: 99%

Prevalence of hypoechoic carotid plaques in coronary artery disease: relationship with coexistent peripheral arterial disease and leukocyte number

et al. 2009

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In coronary artery disease (CAD), a concomitant peripheral arterial disease (PAD) entails a more severe coronary atherosclerosis. We hypothesized that the severity of carotid artery disease is greater in CAD+PAD than in CAD alone. In 90 CAD and 79 CAD+PAD patients, carotid plaque echolucency was measured by gray-scale median (GSM), and the degree of carotid stenosis by routine Doppler criteria. Plaques were absent in 20 (22.2%) CAD and 8 (10.1%) CAD+PAD patients (p = 0.035), while the prevalence of carotid stenosis ≥ 50% was 16.7% and 25.3%, respectively (p = 0.166). The GSM score was 45.1 [21.7-67.7] in CAD+PAD vs 60.1 [44.9-83.1] in CAD alone (p < 0.001). Consistently, hypoechoic plaques (GSM < 25th percentile) were more common in CAD+PAD than in CAD patients (38.0% vs 11.4%, p < 0.001). On multivariate analysis, CAD+PAD was the only variable significantly associated with hypoechoic plaques (OR = 4.16, 95% CI 1.68-10.28). However, when the leukocyte count was added to the model, it showed the strongest association with hypoechoic plaques (OR = 6.70, 95% CI 2.13-21.10). In conclusion, compared with CAD alone patients, those with concomitant PAD showed a greater prevalence of plaques with characteristics of instability. Thus, our data suggest that in CAD+PAD, evaluation of carotid plaque echogenicity could contribute to improve clinical decision-making and differentiate treatments for individual patients.

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Computer-Assisted Ultrasonographic Analysis of Carotid Plaques in Relation to Cerebrovascular Symptoms, Cerebral Infarction, and Histology

Cited by 36 publications

References 26 publications

Correlation Between Carotid Intraplaque Hemorrhage and Clinical Symptoms

Correlation Between Carotid Intraplaque Hemorrhage and Clinical Symptoms

Stratified Gray-Scale Median Analysis and Color Mapping of the Carotid Plaque

Prevalence of hypoechoic carotid plaques in coronary artery disease: relationship with coexistent peripheral arterial disease and leukocyte number

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